This week at HTN, we’ve been publishing a series of thought leadership features with insight from a range of health tech professionals; so far we have covered AI and data; patient flow and how to support hospital efficiencies; shared care records and the benefits of improving patient records. Now, we’re turning our attention to digital primary care, and looking at some of the insights that digital health experts have shared with us over the past months.
In August, we hosted a panel on digital primary care in which we were joined panellists including GP and chief clinical information officer at North East London ICB Dr Osman Bhatti and Surrey Heartlands ICS’s directory of primary care Nikki Mallinder.
Osman shared insights into the role of digital in managing access and demand in primary care. “I compare online consultations to opening an extra tap into the overflowing bathtub – before you do that, you need to make sure that the other taps have been turned down, so that you’re not just doing your face-to-face telephone consultations and then introducing long-term constraints on top,” he said.
In terms of tackling this challenge, Osman shared how the ICB changed their approach. “Historically, North East London had one online consultation provider, and with consultation with our practices, we soon discovered that one size doesn’t fit all.” Instead, they opted for an approach where practices had “had the choice of one of three different online consultation providers, which has increased the uptake.”
Looking at digital tools for long-term condition management, Nikki highlighted the importance of improving data use. “In general practice, I think we see the same people for the same condition for the same amount of time; but actually we need to highlight those who are going through something slightly different or have changed or have moved into certain spheres,” she said. “So I think the work that we’ve done on bringing all the data into one digital platform is really significant. How we reach out to populations for long-term conditions is really important, because some people are really good at giving you the information that you need upfront. But some people aren’t as good at it; we need to start remembering that actually we could start to respond to different cohorts of patients in different ways.”
Osman noted that data standardisation is key here, too, explaining that one factor that has helped his ICB is their clinical effectiveness group. “Over the last two years I’ve been seeing patients who haven’t had their blood pressure or weight checked and it’s changed dramatically,” he said, acknowledging that in the past, monitoring of those with long-term conditions hasn’t always been of good quality. “The clinical effectiveness group has helped us to standardise the data going in – as long as everybody’s got the same standardised way of entering all of the data and we’re coding everything well, then we can see the dashboard correctly. We can output to practices and build protocols, searches and bespoke pathways. It means that practices can say, ‘Here’s a cohort of diabetics that haven’t been reviewed’, and it’s stratified that risk.”
Looking at the role of the NHS App in primary care, Nikki said, “I think sometimes we underplay some of the things that are in front of us and we don’t utilise them to the best they could be. I think the information is out there, but patients need to know where to go and how to access the right thing. It’s about time and sharing learning.” She noted that her ICS is tackling this by focusing on improving their consistency. “Through all of the insight work that we’ve done with patients, something that often comes up is the inconsistency of how they get dealt with as they come into the system,” she noted. “We’re trying to get a little bit more of a consistent offering across the practices.”
Osman also raised a key point with regards to the NHS App. “I think the main point is: if it’s not working, then change something. Try something different.”
He commented that when his practice rolled out the app, they “were wondering why we weren’t getting traction – it should just be a case of picking up your smartphone and it being intuitive. But we found that staff didn’t really know about the NHS App, so how could they inform patients? We got staff to use it for themselves, to see how it works, and then it’s much easier for them to explain to other people how to use it. Sometimes, we just need to stop and think if things aren’t working, rather than pushing the agenda forwards at all costs.”
When it comes to engaging patients and staff to use digital tools, Osman had another tip to share from North East London ICB. “When we’ve looked at how to develop clinical leads, we’ve soon found that it doesn’t actually have to be a clinician; you can have a digital leader rather than a clinical digital leader. In my role at North East London, I’ve asked every PCN to nominate a digital person that can liaise with me; so rather than dealing with 260 practices, I’m dealing with 42 PCNs. You just need an enthusiastic conduit – it could be an enthusiastic receptionist who leads on digital in the practice and can then disseminate things across the PCN. It’s really working well for us in terms of getting that information back and forth.”
We’ve also heard plenty insights from Dr Minal Bakhai, national director for primary transformation at NHS England; Minal joined us in February to discuss how general practical can be supported to create a sustainable future. As part of her talk, Minal highlighted how getting the right communication in place is key for supporting digital primary care.
She commented on a communications pilot rolled out in Humber Coast and Vale which showed “a healthy appetite from patients when it comes to using digital routes.” 53 percent of the patients surveyed indicated that they were “very open” to using an online consultation system; however, only 14 percent were aware that online consultation systems existed.
“This showed that we need to build awareness of these contact routes, but also to build patient confidence,” Minal stated.
With regards to supporting both staff and patients, Minal discussed the General Practice Inclusive Access Route evaluation from January this year. The evaluation found that once the whole practice team had developed an understanding of how to support online consultation requests, they felt it was “easier to build confidence” for both patients and staff with regards to digital primary care tools.
Another tip from the evaluation included the fact that practices with less experience of digital tools would benefit from linking up with more experienced practices to facilitate knowledge-sharing. In addition, user research around the project highlighted that the keywords that patients search for when navigating digital journeys doesn’t always match up with the language currently used on GP websites. Minal said that “common approach to language across digital tools in the NHS would help increase the usability of products” and added that this learning had been incorporated into the NHS design guide. Minal expanded on this point further in another session with HTN, in which she shared tips and advice on to improve the digital journey for patients.
Explore digital primary care further on our website; earlier in the summer published our deep dive into what ‘good’ looks like in digital primary care, and check out April’s feature series on digital primary care here.
The finalists in the category of ‘best use of digital in primary care’ for our HTN Awards 2023 showcase a range of best practice examples from a variety of projects and programmes; click here to find out more.