For our next digital primary care feature, we chatted to Helen Holmes-Fogg and Lisa Drake of Redmoor Health. Helen and Lisa discussed their thoughts on access to digital solutions, developing digital teams – and how ‘digital’ isn’t necessarily the right word for an enabling tool in healthcare.
Hi Helen and Lisa, can you tell us about your roles?
Helen: I’m the director of strategy and development at Redmoor. My remit is to take a strategic view of the NHS and translate policy and drivers into meaningful commissioning and service delivery design. My background is 25 years of NHS urgent and primary care network (PCN) delivery as a director of operations and over the past five years I’ve been a GP Federation CEO, so I have strong connection with day-to-day challenges alongside the need to transform.
Lisa: I’m the director of quality, services and improvement. I’ve been with Redmoor for about five years now following 20 years in the NHS. My work is around trying to bridge the gap between commissioners who have funds to spend and priorities to deliver, and general practice, which is focused on provision of services, as sometimes those two things don’t always match. My background is in practice management and commissioning, so I can see things from both sides and I can try to help them together.
Redmoor Health has a fairly broad spectrum of services. We have a delivery team, who focus on supporting practices around quality improvements, optimising the digital solutions that integrated care boards (ICBs) may have purchased on their behalf, and trying to get the best out of those products. It’s about helping practices to get the most out of their processes, their people, their culture.
Then there’s the development side of the organisation, which is all about transformation around PCNs and working at scale. That’s about making sure that there is consistency across those practices and PCNs so that patients get a similar experience, and practice teams can work in more effective ways.
We also have a creative and communications team: producing high quality content, then using social media to broadcast messages, in turn, supporting practices with their patient communications and education.
Helen: Although we are identified as a digital health partner, you can’t have digital in isolation. The work that we do has to be embedded in what is happening in practices, PCNs, ICBs, integrated neighbourhood teams (INTs) and so on.
Digital access now and in the future
Lisa: There is a strong focus on access in the new GP contract, perhaps scaling back some of the more complicated features that have been there in recent years and really focusing on patient experience. Whether a patient books online, walks into the surgery, or uses the telephone, the outcomes need to be consistent.
We use the phrase ‘don’t talk digital, talk progress’, and I think that comes back to the fact that everything we do digitally in our every day lives should be available to us in health as well. We bank online, book holidays online, there are plenty of secure gov.uk services – but we don’t seem to have made the same progress in health, although the pandemic did catapult us forwards somewhat.
Taking a step back now, some of those solutions were rushed in through necessity. We’re working with a lot of areas to reset and think about what that mixed offer of care needs to look like.
We’re trying to make sure that ‘digital access’ is placed as part of access in general. It will be different for different patients at different times, but we need to make sure that patients understand the options available to them and practice support with the best product or process to meet those different needs.
Helen: Thinking about the wider landscape, there’s also the Fuller stocktake and the introduction of integrated neighbourhood teams to take into account.
Day-to-day frontline services have really taken up the digital agenda, and there’s work to be done within that, but I also think we’ve got to start looking at this from an infrastructure point of view. If you think about practices being part of PCNs, being part of INTs, there’s a question around how we get an IT infrastructure across all of this, and across the country. It needs to be integrated with partners such as our social care colleagues, the third sector, community care – we’ve all got to be able to talk to each other digitally.
So I think there’s a lot of work to be done at a fundamental level to support the frontline to effectively adopt, use and embed their digital assets. It doesn’t have to be complicated.
Benefits of working at scale
Helen: You’ve got to keep things in perspective. Scale is great and it can really optimise our ways of working, but it would be remiss to say that scale works for everything; we’re very clear that it has got to be for the right reasons and for the right outcomes. That’s from a professional viewpoint and from a patient perspective.
If we look at the way that primary care works, there’s a lot of repetition. We have individual practices and individual PCNs which could do things on a larger scale or through substantial infrastructure, supported by alliances, federations or wider collaboratives. People are busy enough without having to duplicate tasks, and there’s an awful lot of back office work that could be done once, freeing up a precious time.
We’ve also got to start thinking about how we can harmonise our wider teams and networks – for example, additional roles in primary care. I think that can only really be done at scale. If it’s done individually, then you lose the flow and impact.
Lisa: There’s also added resilience in working at scale. There are some practices that are really struggling at the moment from a capacity perspective. Every single practice in the country cannot have the blend of certain professionals with the same skills to deliver services. Being able to look across a PCN team means you can have people working to their strengths, and on behalf of each other. You might have two or three people within that network who have the specialised skills you need, rather than it all falling on the shoulders of an individual practice.
Having said that, you’ve got to ensure that you pick the key factors that will make a big difference in terms of that collaboration. That’s where the focus of the new ‘access’ element within the GP contract will help – let’s stop doing lots of tiny things separately, and start focusing on a few key things together.
Contextualising and optimising
Lisa: We’ve seen layer upon layer of additional technology delivered over the last few years with many platforms and different suppliers. I recently spoke to a commissioning colleague; they commented on how much software and technology they have bought over the past years, but felt that they are in a situation where not everybody is using everything, or well. In fact, in some places, they’ve even not using the fundamentals of the product.
I think we need to go back to those early stage building blocks. What are we trying to do? How are we delivering that? Which is the best product to do that?
We need to accept that there is no one product or supplier that can provide a solution for all of the different service offers – it’s about finding the best fit for the problem at hand. We also need to make sure that most practices and PCNs are using that solution optimally, before we layer on another solution; all that does is add more complexity and confusion. It also means that commissioners aren’t getting value for money out of their purchases, because organisations aren’t using them as effectively as they might be. That could be because they haven’t had the time to train teams properly, or the product doesn’t actually meet the needs of the practice team.
Helen: We can’t just a stick a piece of tech in to resolve a problem. The optimisation is also around people’s clinical and operating workflows. Sometimes people try to fit clinical or operating models around the tech, rather than tech complimenting or enabling their work, whether that’s the care that they are providing or the admin that needs completing. As Lisa said, it’s about going back to the beginning and harmonising how the technology and workflows blend together.
How can healthcare work in a smarter way?
Helen: The challenge is that everyone is so busy. Everyone has their heads down, for all the right reasons, but we need to lift our heads above the parapet and look at how we can – and should – change.
We’ve seen a lot of change already from a commissioning landscape with the introduction of the ICSs, and I think we’ve possibly lost quite a lot of continuity in that. Now, it’s about honing in and trying to get smarter. We need to identify our support networks – what are the roles within our commissioning bodies that support our frontline workers? Because that’s what ICSs are there to do – yes, they set the strategies, but it’s also their job to find ways to support our frontline colleagues and enable that support to happen in practice. For example, when we’ve got infrastructure in place, it’s not just about holding up a range of technologies and telling organisations to pick and choose; it’s about smartly commissioning those technologies that work best across a patch.
With primary care in particular, it can be difficult as there are so many islands within it. Primary care needs to be represented from a wider perspective and we need to find smarter ways of working to bridge those gaps – to communicate better, both between primary care facets and outwardly to our patient populations. We’ve got to change the tide on how we communicate engage with patients going forward. Particularly around our understanding of their needs and in how we educate them in our changing healthcare landscape.
Lisa: It’s worth thinking about it at the simplest level – if we take a patient journey, for example, ordering a repeat medication online, what is it we are trying to achieve? It’s very simple to order medication on the NHS App, but how many people are doing that at the moment? If we nudge that along just slightly – if every single practice increased their NHS App users by five percent, and people ordered medicines online – it would improve the patient experience for those people and reduce a lot of waste. It’s a fairly simple thing for us to do, and yet we don’t focus on things like this. Again, it’s about doing the basics before we layer in complexities.
Developing staff trust
Lisa: Digital, in itself, is not a very good description for what we are trying to do, and I think the terminology leads to digital sitting in a little isolated bubble. For some people, the word digital has connotations of IT. They will tell you that they are not ‘IT-savvy’, yet they’re sitting there on their smartphone, checking social media, booking cinema tickets for the weekend; so they are confident using it for things outside of work. But if people don’t feel confident in digital tools as a provider of healthcare, they are not going to be able to convey that confidence to patients. I think there’s something to be said for getting rid of the terminology around digital – it, essentially, is just an enabling function of healthcare. We need to make it more simple for people; it’s just ‘the stuff’ we do in our everyday lives. It’s not about digital, it’s about 21st century healthcare.
Helen: We need to make sure as employers that we actually acknowledge that the world has changed significantly and will continue to evolve always. It’s so important that we develop our own staff, giving them the time and space to learn. The structure of an acute trust is quite linear and you could argue, easier to effect disseminated change processes. However, within primary care you’ve got single-handed GP practices all the way through to huge alliances and everything in between. We’ve got to make sure that we are being inclusive for our own staff and support them to tackle change but in bite-sized, manageable chunks with protected time like in other sectors.
Also, taking a commissioners’ perspective; it’s not only about purchasing technology, it’s also about the filtering of support all the way through to grassroots level. In the last couple of years, Redmoor has been part of a lot of conversations where the focus is on saying ‘we’ve got the tech – how do we support people to adopt it and embed it?’ That’s where we come in; we can do the hand-holding, provide coaching support, and provide learning and developing environments on their behalf.
Lisa: Historically, the NHS is very good at regulated training, for people in roles who require registered training. But we’ve not had the equivalent for non-clinical staff. In terms of budget and time out of work, non-clinical roles are not given the same time or space to develop. We’re trying to build tools and systems for people to learn in small bursts, because often that’s all people have got in terms of capacity.
Sharing good practice
Helen: We are part of the What Good Looks Like national programme, which focuses on blueprinting. When an organisation undertakes a digital transformation journey, Redmoor is always keen to learn about that experience and hear how it went for them, so we are always looking to develop use cases, case studies and blueprinting processes. Between our day-to-day focus on this and the national programme, which is going to be providing blueprints for primary care and social care on the NHS Futures platform, we’re making sure that we’re offering a real view of what happens on these journeys and what people might want to consider.
A lot of the commissioners, ICBs and regional teams that we work with are always keen to think about the legacy of projects and programmes, so that they can self-sustain their learning and growth.
Lisa: We also have a system called the digital journey planner that helps teams at practice level. It provides a building block approach – we’ve provided learning resources and materials on what good looks like, and there are also bite-sized assessments, where people can check their current knowledge and service delivery. We’ve also provided practices with the ability to make a plan, so that they can decide what they want to work on now and what they want in the long-term, but most importantly what they want to work on together as a network. That helps practices to identify individuals with particular skillsets which can then be shared across the network.
Hopes for the future
Lisa: I’d like to see real focus on the user experience and user centred design of software and services, particularly the user experience of the people providing the service. We’re getting very good at looking at patient experience, but we still have a way to go to look at what that feels like for the people in the middle, who may be trying to provide that service and/or configure that system.
I think we’ve had products released onto the market too early without robust user testing, due to the pandemic and due to the fact that the market for these products exist and so they can get rushed out. But that leads to inefficiencies because the product doesn’t quite do what you need it to. That adds pain points, both for the providers and the patient. So I’d say we need some good user research from a provider perspective.
Helen: I’d like to see more joined-up conversations at a commissioning level. As we’ve said, there has been so much change, and a lot of it is bringing people closer together which is positive; but the shifting of systems and it’s people are generating the greatest challenge to progress for those looking for strong leadership and continuity. So I’d like to see variations and new methods of communication and particularly more conversations between digital and primary care, so that the two aren’t sending different messages out into the system.
Coming back to Lisa’s point, I’d also like to see a stop to the segregation of digital as separate part of healthcare. It’s simply our daily way of operating, an enabling tool. We’re always looking for new opportunities to do it and grow it and do things well, but infrastructure plays a vital part in that. We’ve got to get our infrastructure and procurement right as a nation so that these technologies have a rapid route to market with a suitable platform through which we can deliver better care.
Many thanks to Helen and Lisa for joining us.
