Interview, NP, Primary Care News

Interview: Sarah Andersen, GP, on digital in primary care and sustainable digital transformation

In a recent interview, we spoke to Sarah Andersen, GP at Herstmonceux Integrative Health Centre in East Sussex. Sarah shared with us some of her recent insights and experiences on a range of digital health topics across primary care.

To begin, we asked Sarah to share a little about herself and her interest in digital health.

“I’m a GP at Herstmonceux Integrative Health Centre, and this year I’ve decided to devote four days a week to working on sustainability – the triple bottom line of environmental, financial, and social sustainability,” Sarah said. “Of course, one of the things that excites me about digital is that it has a pivotal role in all those areas.”

Reimagining the practice website

“In 2020, while it was quiet-ish, while we all got used to our new locked down lives, I thought I’d redesign our practice website.

“Something like a third of adults have done a Google search on a health issue in the last six months, so I thought what would help me in consultations would be a digital tool that I could use in my surgery, that would be useful to my population in front of me. I’ve always practiced what I call ‘sticky medicine’, where patients come in with a list of issues and I write them down on a sticky post it note, along with my suggestions. A lot of those I found were websites or other digital tools like an OCD app or a Ted Talk. I was handing those out to people, but I couldn’t do that in lockdown over the telephone.

“I thought it would be great to have a practice website where you could put your favourites for instance regarding local mental health resources all on a page, then it would be a resource that they could use. They could also revisit it if they had another episode in the future and wanted a reminder, or they could also share it with their friends or family. For instance, in someone experiencing bereavement, there are some useful articles or things that I would suggest when I saw them: locally curated health resources that they could find online, that might help. If your local GP had curated a site for you, and you felt comfortable with that doctor, then you might feel more comfortable with it. It is a question of building up trust.”

When Sarah started the project, she sought help from relevant sources – for example, getting her teenage children to help design the ‘teenage page’. “We enjoyed putting it together. There’s a link to what happens during puberty to a video from a comedian on YouTube that only a teenager could find!”

Sarah sought to create a resource that she could use in her consultations and which would save a lot of time. “If I have a consultation with a mum and on her way out she comments that she’s worried about the mental health of her teenager, I could then offer a place to begin. This isn’t replacing medical care in any way; it’s enabling people to take better care of themselves and feel a little bit cared for, by us offering a curated resources for free.”

Through the project, Sarah estimates that over 150 pages were created for the website containing information relevant to the local population.

A Leadership Fellowship with a focus on digital inclusion

“The reason I applied for a Health Education England and Kent Surrey and Sussex leadership fellowship was to focus on digital inclusion and expand on the website that I had started with some help from the practice team,” she said. “I had that resource available, but maybe I was the only one using it. My fellowship year, 2022, was all a bit hampered by circumstance at the beginning – the backlog created by the end of the pandemic, staff sickness, and so on. As in the NHS we run quite a lean service, it feels as though when these immediate crises happen, other projects all lose momentum. So sometimes those projects that might actually improve your efficiency in the long term, like digital, get pushed aside whilst we deal the day-to-day.”

Sarah explained how she interviewed staff and patients in the waiting room as part of the quality improvement framework that she was using for the digital fellowship project. “I asked them what they thought about digital, and whether they’d ever used our website. Results tended to be disappointing – people had been on it to find the address of the surgery and the opening times, and I did get some people saying that they just don’t like using digital tools. Interestingly, though, I found that in my small sample of 30 people, the older people were more digitally savvy. I got more of a brush-off from younger people, like young mums who would say that they were really busy, they might look on social media but they weren’t interested in a website. A lot of the 70- and 80-year-olds were more enthusiastic than some of our own reception team!”

Sarah moved on to talk to us about how she had endeavoured to introduce or encourage digital solutions which would support her practice’s team, saying: “I asked the reception team – because they’re key to the functioning of a successful primary care team – ‘What would help you?’ They said they spent over an hour a day processing paper prescriptions, and that if people could use the NHS App instead, that would be much better. So I pushed the app, and I worked with our patient participation group, putting posters up in the waiting room and pharmacy to push the NHS App. Less than 50 percent of our patients were using the NHS app in the older age group, and after six months of the project it was over 60 percent; still a lot missing, but it felt like a trend right direction.

“In terms of digital inclusion, I worked on putting resources up on the site for groups that I noted weren’t spending much time on the website. For example, I wrote some pages on hormone replacement therapy, because I was trying to attract more women and pages on dementia to bring in older users. I used Google Analytics to check up on how that was progressing. I found it a bit addictive actually. ”

Moving forwards – and a new project, this time designed with the community

We asked Sarah what her current digital priorities were, both on a personal and a practice level.

“The practice website is up and running, but once you set up a website, that is just the beginning, and it needs maintaining – it feels like gardening! Unless you maintain it every month, things start to go awry and links no longer work, and then it becomes a sad and dismal place to be.”

Sarah mentioned that after she saw an advert for the Healthy Futures Action Fund, she applied for a grant with people who lived in the local village. She asked what they could or would do to be healthier and to be a more sustainable village, with residents suggesting that they wanted to encourage active travel, particularly to and from the school or health centre.

“We decided that putting some information about that on a digital notice board would be really helpful. So the residents developed and ran a project on walking more, which was aimed at starting to shift the culture of the village towards being more active – it was about taking simple steps, like suggesting that people walked their kids to school more. We measured and divided the carbon footprint of our health centre – what we spend on health, the medicines we produce and the disposal of those medicines – amongst our practise population, and figured out that if every person who is registered at the surgery walked and average of 111 more miles per year, which is like doing a short school run on foot, then that would offset the whole carbon footprint of the practice.

“That was one step towards making people more environmentally and digitally aware, but I would love to develop those ideas further. There’s so much scope for communicating within a rural population and using digital tools seems like the obvious way to do that.”

Sarah commented that there is an idea that “if you’re using digital, you’re at home”. She said: “It’s not true. A 2016 MORI poll showed that there’s a link between your digital activity and your community engagement, and there is an inverse correlation with healthcare use. If you think of the older people you know, the ones who are more digitally savvy, see what’s on locally, book tickets and go out to see concerts or the football with their friends are the ones who tend to be healthier.”

Where is sustainability?

On the topic of sustainability, Sarah noted that she visited the Wired digital conference where she was one of hundreds in a room listening to people on stage “talking about the future and amazing, streamlined, efficient patient journeys, particularly through hospitals”. She raised a question at the end asking where environmental sustainability fits in and commented that she found the answers “deeply disappointing – I’m sure they had thought about it, but it just didn’t come across as a priority. I was a bit shocked at how there wasn’t a big push towards environmental concerns threaded through the digital transformation that they were talking about. There was a small stage dedicated to environmental sustainability, and even though the things they were talking about were major – like an IT meltdown that happened to a hospital in London where their system overheated and they lost their IT for a number of days – this seemed like a small thing to also consider, rather than being a fundamental part of digital transformation.”

In Sarah’s view, this is an “exciting time, because so many things are accelerating exponentially. I really hope that the people who are designing the architecture of AI and other digital designs have the wider interests of the population and sustainability issues in mind. Everybody has their own part to play.”

 And one final thought…

Sarah commented that a good friend of hers has been working in digital since 1999 has recently also switched to working on environmental goals. “She said that the sustainability transformation now feels exactly the same as the digital transformation felt back in the early 2000s – an exciting area of growth. The science is clear that change across all sectors is coming: lets hope that the digital world can embrace it and run with it!”

Many thanks to Sarah for joining us and sharing her thoughts.

To read more about the Herstmonceux Fitter Village Healthy Planet project, please click here.