Feature Content, Primary Care News

“Services aren’t looking for digital platforms that just open another lane on the motorway” Craig Oates on navigating care pathways

For our digital primary care feature series, we spoke to Craig Oates, managing director of Doctrin UK. Craig discussed the solution offered by Doctrin, his thoughts on the challenges facing primary care, the benefits of using the right pathways, and more.

Hi Craig, could you take us briefly through your career background?

Over the course of more than 30 years, I have devoted my career to the healthcare industry. During my first 14 years working in the sector, I held several roles within the Department of Health and Social Care. Later, I went on to serve as the Director of a primary care trust, and held senior roles in a number of Acute Trusts, including as the Chief Information Officer at University Hospitals of Leicester NHS Trust. I also have experience working as both a management consultant and in leading healthcare software companies. I am currently the Managing Director of Doctrin in the UK, in a bespoke role that sees me responsible for the company’s UK and international growth. With experience spanning the healthcare industry as a customer, supplier, and advisor, combined with my personal experience of healthcare, I am intimately familiar with the realities of being a patient in today’s healthcare system.

Care navigation, true patient workflow

Doctrin was established in 2016 by a team in Sweden who looked at healthcare systems and noticed a lack of communication and joined-up working between platforms. In my role as CIO at University Hospitals of Leicester NHS Trust, I dealt with more than 250 platforms, most of which didn’t speak to each other, making it difficult for clinicians to deliver efficient care and interact with patients effectively.

If you look at some of the first-generation digital consultation platforms, they primarily functioned as a means of consultation, without incorporating elements of care navigation, true patient triage or workflow. Recognising this gap, Doctrin identified an opportunity to provide support for care navigation, going beyond a patient-clinician communication service to provide a golden thread throughout the patient’s care journey. From the moment the patient first presents, the platform offers comprehensive care support for patients and their caregivers.

Doctrin was introduced to the UK in 2020, and in October 2021, we went live with our first pilot. Since then, we have implemented our platform at multiple customer sites, including both NHS and private organisations. In short, Doctrin works by providing patients with a clinical questionnaire to complete based on their concerns, directing them to appropriate services, or recommending self-care options where appropriate. The platform then routes the patient’s query or concern to the most appropriate team for them to provide digital or physical care and advice as needed, in the platform or using our video capabilities. For us, it is critical that the platform is clinically assured as a registered medical device and also assured by ORCHA to demonstrate that we can support the delivery of safe, effective and timely care.

The Doctrin platform is aligned with the objectives of the NHS, which strive to promote efficient working practices by directing cases to the appropriate level of qualification, rather than creating bottlenecks by sending all cases to a single level or team. Our platform doesn’t just unload cases onto a healthcare team, it enables care navigation. This helps healthcare organisations significantly increase their efficiency and capacity, providing a better experience for patients and staff, and allowing integrated care across care settings and providers, expediting a patients’ care journey.

In terms of scale, the platform can work within a unit, a practice, a hospital team, across the entire primary care network, or an integrated care system.

Benefits of receiving treatment through the right pathways

Healthcare services aren’t looking for digital platforms that just open another lane on the motorway. Done in isolation, increasing access does not help, it only overwhelms the healthcare settings faster. Doctrin aims to speed up and streamline the care-navigation process by making sure that the patient gets through to the right person in the first instance. We divert patients who can safely go to other services, or who do not require clinical support, reducing access pressure. We also recognise the need to do more than simply providing technology; to maximise the potential of digital transformation projects, suppliers need to support their customers to make change happen, which is why we have a team of experienced change managers to support each and every client.

We’ve got evidence showing that our platform delivers a 30 percent increase in capacity. Our first practice in Stockholm, for example, had an average wait time of five-weeks for patients, which went down to two days following the implementation of Doctrin. And at the Lakeside Healthcare Partnership – our first UK site – more than 90 percent of patients gave positive feedback across eight sites in the East Midlands.

Because of the increase in capacity provided by Doctrin, healthcare teams can work more efficiently and improve the quality of care they provide. For instance, if a GP sees a patient and they are concerned about their skin condition, they can collaborate with a dermatologist from secondary care, either in private or public, through the platform, enabling a more thorough examination and consultation, with better outcomes for their patients.

Challenges and how to tackle them

Picking the right platform isn’t the challenge, the challenge is encouraging people to adopt change. If you’ve been working in the same way for years, it can be daunting to change your routine. As such, you can’t just introduce new ways of working to a healthcare setting without helping staff to manage the transition – if you do, you may not realise the benefits you were hoping to see.

As a starting point, it’s important to listen to clinicians. What are their problems, and how can we work with them to redesign workflows and address them? As for patients, their expectations can be a major challenge. There’s a huge, honest debate to have with patients about whether their expectations are realistically achievable for healthcare services. We need to stress that we will give them the right care at the right time, and offer digital support when it can meet their needs. Or to put it simply, we need digi-physical care – digital where possible, physical when needed.

On how Doctrin integrates with pathways

The Doctrin platform works as a standalone solution, even in settings with limited digital infrastructure and low integration demand. However, in the UK, there is a major focus on integration, which we have developed with TPP SystmOne, EMIS and Vision to enable the whole PDF of a patient’s record to flow into the platform. We are also developing the capacity to manage bulk send-outs, which will enable Doctrin to send SMS messages to all registered patients, encouraging them to complete their annual health check online through a clinically coded integration.

Statistics suggest that 70 percent of healthcare costs are spent on 14-17 percent of patients with multiple chronic diseases. If we can better manage people in primary care pathways and offer proactive care, we can prevent conditions from worsening, which is better for patients, and better for the NHS as it reduces the volume of high-cost, urgent care interventions.

The real benefit of integrating pathways is that you can treat patients who need immediate care faster. The introduction of new roles, such as first-contact physios and social prescribers, have expanded the scope of care pathways beyond GPs and hospital nurses. When used effectively, these roles connect clinical care with social care, creating a broader support network that can address patients’ wider needs.

If you look at mental health as an example, clinicians can offer the right care, counselling and support, but actually, these problems might be driven by an issue such as stress over debt. Through Doctrin, you can bring in third sector support through reputable, safe partners who can help resolve social issues at source, offering more holistic care.

That’s what pathways are about: delivering services at a large scale, but with individualised care. Every patient has their own golden thread from the moment they come into the practice to when they leave, which weaves through an incredibly complex system. Doctrin makes this process seamless, so you can treat people faster, stop them from deteriorating, reduce costs, increase workforce capacity, and retain people in practice.

Primary care tools reducing urgent care pressures

In areas where GP provision isn’t as good, the default care setting tends to be the emergency department (ED). Urgent treatment centres (UTCs) also help support when practices are closed or overwhelmed, providing a halfway house between the GP and the ED.

We’re currently in conversation with a number of urgent treatment centres and are aware of the challenges they face – from people coming into the centre for non-urgent needs to patients getting bounced about between settings and presenting at the wrong place. They are inundated with patients and, as a result, the centres often run over their hours, which has a workforce impact. By making a platform like Doctrin the first point-of-call for patients, those who don’t need urgent care can be treated digitally or signposted to a more appropriate service. Doctrin can also let patients know where urgent treatment centres may not be able to help them so that they don’t make unnecessary journeys.

By having the platform as the initial point of contact, UTCs gain the advantage of knowing who is seeking care and why, allowing healthcare professionals to prepare accordingly. Further to this, if an organisation is using software like e-prescribing, patients can be evaluated through Doctrin and receive prescriptions from a pharmacy without needing to present in person. The aim is not to discourage in-person care, but rather to provide patients with more effective digital care whenever possible, and to streamline the system for faster processing times and reduced clinician workload.

Additionally, Doctrin’s analytical features enable UTCs to comprehend patient behaviour, preventing them from becoming overwhelmed and assisting them in managing demand. This also presents an opportunity to recognise and address the underlying causes at the source, meaning that they can better understand demand and design their workforce to better meet it.

Thoughts on the future

In the future, I’d like to see a focus on highlighting the specific benefits technology can have on a service and on its role as a change enabler. Even though technology is absolutely the key to success of healthcare provisions, we have far too much technology being thrown at things. To achieve success, we need to really engage with colleagues in healthcare and listen to their needs – if a healthcare professional isn’t into tech, we need to listen to their perspective and see how we can make digital tools effective for them.

One of the key challenges we face within our healthcare services is around fragmentation of care. Digital can bring the pieces together, helping the healthcare system develop a population health solution. We’ve currently got PCNs and ICSs trying to figure out how they are going to work, and going about it in very different ways. By integrating systems together, we can make sure they have a united approach in their delivery of care to patients.

The solution is a one-stop shop for patients, regardless of the complexity of the care they need, where they can see their medical records and receive care through multiple pathways. And in my opinion, the NHS App has huge potential for providing a simplified digital front door for patients

Five years from now, I’d like to see technology both increase access and make clinicians’ lives easier. We need to think about how we can provide a better work-life balance for clinicians, which is a massive issue at the moment and one that technology can support. One of our customers had a 21 percent turnover for staff – following the introduction of Doctrin, that number went down to 9 percent.

Our newest UK customer, Marston Forest, has done some incredible work in improving staff experience whilst also helping patients. They had five GPs handling 30 cases each every day. Doctrin was able to provide them with a new way of working by streamlining their workflows and making them more efficient. The introduction of Doctrin’s platform has meant their GPs are now handling up to 50 cases each day, almost doubling the amount they could previously treat. The practice is seeing an additional 100 cases every day, and staff time has been freed up to let GPs have a better work-life balance.

Also, it’s important to hold all suppliers to account. Through our Medical Device registration processes, ORCHA and the many other key standards for suppliers, we can assure our customers and their patients that we provide a safe, effective and clinically assured platform. We need to ensure our customers get safe and secure systems that are up to the task, working in partnership with NHS England and other providers to support our healthcare colleagues and their patients as we begin to do things differently, making big but necessary changes across the NHS.

Many thanks to Craig for taking the time to join us.