Thought leadership: the digital landscape for PCNs and practice managers
With the National General Practice Improvement Programme underway to guide practices and primary care networks (PCNs) through making improvements across this year and into 2025, and the delivery plan for recovering access to primary care committing to supporting practices to move to a modern general practice model, digital has a key enabling role.
Dr Minal Bakhai, GP and director for primary care transformation at NHS England, joined HTN last year for a discussion on primary care’s evolution. “The current model of general practice as we know it isn’t working for most patients or most staff, and this is almost universal,” said Minal. “Patient experience of access has fallen across the majority of practices and on average, the number of clinical consultations have increased by at least 15 percent, the number of experienced GPs has fallen, and practices are managing 17 percent more patients than they were eight years ago. Essentially we have a growing demand and capacity gap.”
Despite these challenges, she added, “patients still rate their experience of care delivery from general practice highly, and I think our workforce and my colleagues need to be commended on achieving that despite the challenges.”
Minal described the new model of modern general practice as a way of organising work that enables practices to see all patient need by providing inclusive, straightforward online and telephone access including the ability to self-serve where appropriate; understand all need through structured information gathering; operate a good care navigation model to develop a more efficient way of getting the right patients to the right person at the right time; prioritise and allocate need safely and equitably; and improve process efficiencies. Catch up on Minal’s insights in full here.
Here we take a deep dive into the digital landscape of primary care to explore priorities and projects; the digital tools that are currently available and guidance in this area; views from primary care; a case study from Restore Records Management, innovations and hopes for the future; and more.
Contents
- Where should the priority lie?
- The digital landscape
- Views from primary care
- Case Study: Restore Records Management supporting practices in Oxfordshire
- Managing patient access
- Resources and guidance
- Further insights
Where should the priority lie?
To kick things off, we asked our audience – made up of healthcare professionals from across sectors and organisations, from NHS providers to suppliers – for their thoughts on where the priority should lie for digital primary care in 2024. Should we be placing focus on improving core systems, interoperability, building digital skills for staff and patients or innovative tech such as AI and RPA?
With a strong lead, 62 per cent of respondents believed that the focus be interoperability.
Improving core systems came in second with 23 per cent of the votes. Followed by 10 per cent choosing innovations such as AI and RPA, and then 5 per cent focusing on digital skills for staff and patients.
A PCN digital transformation lead when voting added: “Before introducing more systems, we need to sort the core systems we already have first. Lack of interoperability creates most of the barriers (and unnecessary additional work!).”
What would you choose? Keep an eye on our LinkedIn here for future poll opportunities.
Restore Records Management supporting practices in Oxfordshire
From paper records…
Alongside the documented challenges within primary care, coupled with rising demand, a key challenge that staff in general practice can often face is that of physical space. Decades of appointments have been recorded manually on paper, and that paper has to be stored somewhere.
The associated challenges are clear. For busy practice staff, visiting a storage space to locate a particular patient record is time-consuming in itself, and that’s not counting the time required to identify the paper file out of the thousands stored there, or the time needed to sift through the record itself. There are financial implications, with costs to utilising space within the practice to store records when that space could be better used for caring; costs to hiring physical storage beyond the walls of the practice; and costs associated with accessing and sharing files. There are challenges with the vulnerability of paper records, both physically given their delicate nature and in terms of security, with greater risks of GDPR breaches or loss of information.
There are knock-on effects for patients, too, with interoperability made more challenging than it already is due to the disconnect between information held in paper documents. It leads to a time-consuming need to manually contact other providers for a patient’s history, which can lead to delays or errors in that patient’s care due to miscommunication; and there are additional financial and security implications from having to post papers securely to the appropriate location.
On top of this, there is the issue of unstructured data. The lack of relevant coding and uniformed data capture makes it more difficult for clinicians to access the information they need, more difficult to notice trends or patterns, and less useful overall when it comes to efficient ways of working – for example, population health management.
… to space, compliance and cost-saving solutions
We heard from Restore Records Management, whose document management and record storage solutions have helped organisations including NHS trusts, UK government departments and charities to digitise their paper.
In October 2021, Oxfordshire CCG (which has since formed part of Buckinghamshire, Oxfordshire and Berkshire West ICB) approached the team with a need to move 90,000 patient files from eight practices across the region. It was a matter of urgency, with a requirement that the locations be cleared by the end of that same year so that the practices involved could re-utilise the space for caring purposes.
Initially, the plan was to store the records at box level, capturing records in range order with a view to keeping the costs minimal. However, Restore Records Management identified that this method could lead to additional costs further down the line as a result of potential difficulties with maintaining a full audit trail. Following discussions to pinpoint the best and most cost-effective approach, Oxfordshire CCG opted to document each patient record individually.
Records were boxed up with the start and end range on each box captured before the files were transported via a fleet of GP-tracked vehicles to secure facilities. There, data capture on the box range was completed upon initial entry into the storage facility, before data entry of each individual record was undertaken. Names, NHS numbers and dates of birth were captured for each patient and uploaded into the Restore Records Management System, with access to this system given to each practice via Restore Web, an online portal. As such, the practice could view the stored records and request them for retrieval as needed.
The project was completed within the agreed timeframe, enabling the practices within the CCG to quickly reutilise the space that had previously been taken up by physical records.
Sarah Harwood, senior commissioning manager for primary care at the CCG, describes how initial discussions enabled the development of a contract for the work to be undertaken, with Restore Records Management also contributing to a responding Data Protection Impact Assessment, supporting the CCG with information governance, and helping to identify risks. “They have been hugely accommodating,” said Sarah, “extremely responsive to any issues that have arisen and very easy to work with.”
In particular, Sarah noted, “Feedback from the practices who have been involved with the project has also been positive.”
Click here to find out how Restore Management can help free up clinical space in your practice.
Insights from primary care
What does the digital healthcare landscape look like at present to people working in PCNs and general practice? For insights, we asked a range of NHS primary care staff for their thoughts.
First up, Ellie Ferguson, PCN manager and digital transformation lead for Culm Valley PCN, shared that a key focus for her lies in using digital to increase access for patients along with using digital platforms to analyse ways in which appointment slots can be better utilised, along with population health management. In terms of the challenges, she commented on a “lack of support from NHSE in regards to digital within primary care. The funding is minimal and there is little to no direction as to where they see the projectory of digital being helpful.”
What would be the most useful for Ellie in her role? She would like “some form of guidance around the DES contract coming to an end and what this will mean for job security and staff wellbeing,” she said. “From a D&T managerial lead aspect I would like to see the NHS implementing change to the platforms they use such as the GPAD as this has many issues the main being it doesn’t report accurately.”
Ellie also commented on the difficulties around finding answers to the questions that arise in roles like hers.
Patrick Denston, practice business manager at Alexander House Surgery and digital transformation manager at Farnborough Primary Care Network, praised the solutions he has found to work well: “Accurx for SMS comms and comms interoperable with Emis, Healthtech1 for registrations and lab results filing, Surgery connect for telephony.”
In terms of gaps, Patrick noted the need for a mass emailing programme geared for healthcare instead of marketing, along with capacity mapping for Emis.
The main challenge he faces? “Inconsistency across areas on the uptake of digital solutions,” he said, whilst the thing that would be most useful to him in his role would be “responsive adaptation of all digital solutions, not just the good ones!”
Sharing her views, Joanne Urquhart-Arnold, practice business manager for Marlborough Surgery at Seaham Primary Care Centre, said: “The digital landscape is very disjointed and it can be quite daunting to navigate, unless you are tech savvy as a practice manager/practice business manager.
“We use a VOIP (Voice over Internet Protocol) phone system with on-screen call board, so staff know how many patients are waiting for their call to be answered. We will shortly be enabling patients to be able to leave a voice message, if they can’t wait in the queue, which will be responded to within two hours of the message being left. We also have Voice Connect, where patients who don’t have the NHS App can order their repeat prescription via a designated telephone line 24 hours a day, seven days per week – it’s a useful tool, but still needs human intervention to process the prescription within our patient software (SystmOne).”
In addition, Joanne said, her surgery has a ‘health kiosk’ where patients can answer some health questionnaires which are automatically uploaded in to their patient records, with the aim of reducing admin burden for the the clinical team.
“Our area is quite deprived, and many of our patients are ‘technologically disadvantaged’,” she noted. “This might be due to the cost of having technologies such as a computer, tablet or mobile phone that can operate the new NHS services, or they don’t have family members who can help them to set up these new digital advancements.” Joanne commented that “the digital divide is increasing” and “more needs to be done to support those of our population who are technologically disadvantaged, so they aren’t left behind.”
She suggested that NHS England should provide industry experts to help GP practices to streamline their processes, “but also help to remove wasteful admin interactions through the use of tailored software solutions – for example, a huge amount of resource is involved in every GP surgery to ‘code clinical correspondence’ from outside of our practice like hospital letters. Technology exists to be able to scan documents and automatically load their details in to software. We could do with an AI version of this for general practice, as many of our admin team are having to review clinical letters, code them and upload them in to our clinical system, which would be more efficient if this could be automated.”
Having the support of the GP partners is critical to be able to introduce anything new in to the practice, Joanne stressed. “If they aren’t aware of the technology and aren’t aware of its benefits, it makes the whole thing more complicated.”
Managing patient access
With the updated GP contract including a requirement to utilise cloud-based telephony, HTN ran a special report examining news and viewpoints on telephony for primary care here.
In August, we heard from Paul Bensley and Derrick Measham from X-on Health, for a discussion on cloud-based telephony and X-on’s service Surgery Connect, which is designed to help manage patient access and rationalise communications.
“Cloud enables us to do things that we previously couldn’t do with the old system; for example, call distribution across a number of sites and organisations. We can route calls depending on patient choice or based on specific knowledge, pertaining to a patient to different groups or extensions,” explained Paul.
He shared how Surgery Connect works with other digital tools to provide a “digital front door”, allowing patients to contact their practice throughout the day. This, Paul said, leads to tangible benefits including “better telephony, better communications, shorter waits and fewer calls. Similarly, integration with digital gives us better data, improved processes, better decisions and ultimately better outcomes.”
Derrick went on to share an example of Surgery Connect in action at Peel Hall Medical Practice, with the total number of inbound calls “reduced by over a half using some of the features we provide”. He added that the practice has seen a 77.3 percent reduction in call time, meaning patient queries are being dealt with much quicker. “A huge contributor to this has been our patient callback feature, which is a technology that allows people to avoid queuing on the phone and listening to hold music or messages. We then phone them back when they are at the front of the queue.”
Catch up on the full session with Paul and Derick here.
Moving on to another facet of access, patient access to records; last year we were joined by Dr Osman Bhatti, GP and chief clinical information officer at North-East London ICB, for a discussion on how his own ICB handled the changes in this area. Osman raised some of the challenges to take into account and shared the ICB’s step-by-step process for enabling patient access.
We also shared news of a project at Holmwood Corner Surgery which saw an online triage system launched to help patients choose the option that best suits them when accessing the practice. In one month, where 2,800 queries were received through the system, more than one third were resolved without the need for an appointment. GP Dr Annette Pautz, Kingston GP said that the “clinically designed system has proven incredibly useful for both patients and the practice”.
Case-finding through data analysis
In our Health Tech Awards, we heard about MendelScan, an AI-powered case-finding software developed by Mendelian that uses uses clinician-built algorithms to capture disease features from electronic patient records and match them against diagnostic criteria for hundreds of rare and hard-to-diagnose diseases.
Mendelian noted that rare disease symptoms often develop gradually and in different organ systems, meaning that patients can present to different doctors for seemingly independent reasons and making it difficult for doctors to make a diagnosis. As such, MendelScan utilises case-finding criteria for hard-to-diagnose diseases which is encoded into its digital library and is ready to apply to any medical record system. The software uses clinician-built algorithms to capture disease features from electronic patient records across entire populations and matches them against the diagnostic criteria for thousands of hard-to-diagnose diseases, running bespoke algorithms to detect early signs and symptoms.
At the time that Mendelian entered MendelScan into our awards, the software was implemented into 64 GP practices, with Mendelian stating that early diagnosis can “save the need for 33 patient interactions ranging from lab tests, investigations, clinical visits and specialist referrals”.
Insights from primary care
From St John’s Way Medical Centre, business manager Sherif Al-Marayati said: “The rise of automation is really exciting as it means that there are lots of tasks that clinical and non-clinical staff within GP practices perform that can be automated. For example, registrations – we’ve been with GP Automate for months now and they have automated hundreds of registrations for us. There are loads of interesting new digital organisations and existing digital organisations that are doing some really exciting things in primary care. I imagine I am not the only person who relies on Accurx, for example, on a daily basis, to perform loads of functions. Their floreys, self-booking links and triaging tool are so useful and are saving my time lots of time.”
In terms of gaps, Sherif commented: “Better funding would be greatly appreciated as I think there can be even more automation to remove lots of bureaucratic tasks that will create lots of value by saving people time. For example Credentially allow recruitment and compliance tasks to be automated but as GP practices are usually SMEs we don’t have the funding available to benefit from some services.”
As for the key challenges Sherif is facing in this area, he said: “One of my bugbears is how the funding works. For example there exists a community on Teams called NHSmail Solution Store which is promoting Microsoft PowerApps, Power Automate and other solutions. These are low-code tools that will allow people in the NHS to create their own automated protocols, their own templates to share tasks but I’ve been told by my ICB that my request for an Environment to build these tools is ‘not to be in scope of the IT service covered by the national allocation funding provided to the ICB by NHSE’. I don’t know if the funding for primary or secondary care is different but this feels disjointed.”
Bex Cottey, business manager at Conisbrough Group Practice, said: “The digital landscape looks rosy for us. We had our initial concerns, but after a situation which forced us into embracing tech (no phones for a significant number of days) we realised it is a brilliant piece of tech that works well for us and our patients. We use Accurx, and use all aspects of the software, from triage (we are a total triage practice), prescription ordering, test results and referral updates and admin queries; to self-book for nurse/HCA appointments and text messaging services. When Accurx adds another feature we are now eager to try it out. Gaining such confidence in embracing this tech means we are now always on the lookout for other ways in which technology can help us in the practice.
On gaps and what else she would like to see in terms of digital, Bex said that the practice is “now on the hunt for solid/reliable AI that will help us process post that comes in from third parties and secondary care, to reduce the burden on our admin teams and clinicians.”
What would be the most useful to Bex in her role? “I use ChatGPT to help me phrase and compose text and use as many software packages as possible to help organise my staff for HR-related issues, such as annual leave, rotas and training,” she shared. “For my benefit, it would be best for me to free up admin time so I can use admin staff to help with some of the tasks that land on my desk. There are so many things that I do, that I can’t imagine tech can help me with, but if I see something I am willing to explore it further and trial things.”
On challenges, Bex noted that digital tools “often need consistency to handle repetitive jobs, which just isn’t available across the NHS – every practice and every hospital department does things slightly differently which machines often can’t handle well.”
She concluded: “I would embrace AI in making GP work quicker, easier and more time efficient, but we can’t even get the basics right in the NHS with reliable hardware or clinical systems that talk to each other easily. How can we run AI in the NHS when we can’t even send records from one practice to another without paper copies being sent too!”
Mani Raman, development manager at Archway Medical Centre (AMC) shared insight into a digital platform developed as a result of AMC’s recognition of the “transformative impacts that digital technologies could have on patient care”, describing how the team “saw an opportunity to dramatically improve the patient experience with a more efficient service.” This led a team of software and integration professionals from a range of digital disciplines to be integrated into the team with the aim of developing a number of NHS-accredited digital care tools.
“We packaged our digital tools into a separate entity called Virtually Health Systems Ltd,” Mani shared. “With the implementation of VHS digital tools into AMC, AMC has transformed its service provision from a traditional general practice setup catering for 4,500 patients in 2019 to an award-winning digital modern general practice model, currently serving 26,000 patients. AMC is the largest GMS provider in NCL ICB and one of the largest in London.”
Resources and guidance
We’ve heard a range of viewpoints from individuals working in primary care settings – so what help is out there to support practice managers, PCN staff and their colleagues in navigating the digital landscape in 2024?
FutureNHS Platform
The FutureNHS Platform offers a ‘PCNs and Practices Support Hub‘ aiming to provide access to up-to-date guidance and resources, including a PCN dashboard designed to help networks understand their local population health priorities and patient benefits. It provides interactive data on performance and achievement for the Investment and Impact Fund indicators along with PCN service delivery and progress with recruitment, with NHSE also providing resources to support individuals in using the dashboard.
There’s the PCN level tool for GP Patient Survey data, designed to support understanding of where good practice can be found and where improvements can be made. The PowerBI interactive tool presents results for each question of the survey at PCN level, compares it to the national result, and also breaks results down by GP practice.
Another workspace on FutureNHS Platform, ‘Primary Care Improvement Connect‘, shares a wealth of resources on the General Practice Improvement Programme, from insight into what the programme covers and its ambitions to information on the offers available to support practices and PCNs. It highlights quality improvement training and events on a virtual calendar and signposts users to an online discussion forum where healthcare professionals can discuss challenges and share ideas or feedback. There are case studies; blogs, vlogs and podcasts; training and development resources; and more.
Then there is the ‘Digital Primary Care’ workspace on the platform which provides further resources on a wide range of digital topics. It is intended as a collaborative learning space in which NHS colleagues can share lessons learned from digital programmes across England and network with colleagues. The workspace offers support on key topics such digital system procurement and digital requirements in the GP contract, along with a range of data-led tools to help staff develop understanding and support decision making.
ARRS roles
The GP access recovery plan, published in May 2023, outlined intentions around developing a sustainable general practice, improving digital access and tools, supporting citizen remote care, building capacity and expanding supporting services such as community pharmacies. HTN reported on the GP access recovery plan with a focus on the role of digital here.
Highlighting plans to build larger multidisciplinary teams, NHSE stated that up to £385 million would be made available in Additional Roles Reimbursement Scheme (ARRS) funding, to continue to grow capacity and expand roles. These roles, NHSE, include a digital and transformation lead; they will focus on assisting practices in their digitisation journey and in undertaking the modern general practice approach.
The plan also highlighted that primary care staff can access a suite of health and wellbeing offers called ‘Looking After You’, with the Practitioner Health Service extended to provide a free, confidential mental health and addiction service.
NHSE added that training around care navigation and digital transformation would be launched to assist with the upskilling of newer roles in general practice; we covered new guidance on general practice navigation in November 2023. The guidance highlights the three key elements of a care navigation model and insights such as the seven key needs for online consultation forms, along with general advice and ‘top tips’.
Also in May, NHSE launched a new programme designed to support PCN digital and transformation leads with core skills, with the aim of helping them to lead transformational change within their organisation. With the first cohort chosen from the summer onwards, a 12-month development programme sees digital and transformation lead ARRS roles supported in areas including quality improvement, data and digital, and transformation management. The cohort is also provided with a peer community to share learnings.
NHS App
The latest updates to ‘NHS App guidance for GP practices’ was made in July 2023. It covers guidance on app features, access training, how to communicate with patients about the app, monitoring patient use of the app and more. Click here to access it.
So what has been happening around the NHS App over the last year? We’ve covered a number of updates on its progress over the last 12 months – let’s take a look at some of the news stories coming out of 2023.
In September, we noted that NHSE is planning an independent review into 10 healthcare apps in order to consider enhancements for the NHS App; the review will look into user experience, features and functionality across the 10 apps with a view to providing insights and recommendations for the future.
Earlier in the year, at London Tech Week, Lord Markham delivered a keynote speech in which he noted plans to introduce mental health and MSK tools into the NHS App.
May saw NHSE announce that patients would be offered a shortlist of at least five care providers to choose from through the NHS App when they are referred by a GP, in order to provide patients with more choice and control over their own care by allowing them to make choices based on preferred selection criteria such as waiting time or distance.
We also took a look at a study published in Research Square which set out how researchers analysed data from 6,356 primary care providers across England to test the association between population characteristics and digital uptake, focusing on the NHS App and primary care service portals. Analysis of 12 months of metadata from providers, up to October 2022, indicated that by the end of this period, more than 37 million patients were activated on the NHS App (67.9 percent of the population). The study found that increased population from the two most socioeconomically deprived quintiles was associated with reduced activation of the app, with the least deprived quintile associated with greater app uptake. Age was another factor affecting uptake, with the 76-85 age group at a lower level of uptake. The researchers found varying association with long-term conditions, with heart failure and chronic pulmonary disorder patients associated with increased uptake; but dementia and mental health patients associated with reduced uptake. Click here to find out more.
Further insights
The HTN team is always looking to chat about digital programmes with NHS healthcare professionals, to learn about your projects, how you have tackled challenges, and share insights, inspiration and best practice with our readers. If you’d like to share your work in digital primary care, feel free to contact amy@htn.co.uk.
We recently spoke with 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, including her focus on sustainable digital transformation.
We interviewed Dr Rajkumar A Shanmugam (Raj), GP, head of the practice team at the Eric Moore Partnership in Warrington, NHS England’s deputy chief medical information officer and chair of the NHS Clinical Leaders Network. Raj discussed his career in primary care including how he has embraced digital technologies to make a difference to people’s lives – both patients and staff.
Last summer HTN hosted a virtual panel featuring Nikki Mallinder (director of primary care at Surrey Heartlands ICS); Dr Paul Wright, (GP, deputy clinical director/IT clinical lead at NHS Greater Manchester and CCIO at Manchester and Trafford Local Care Organisation); Jamie Innes (product director at Inhealthcare); and Dr Osman Bhatti (GP and CCIO at North East London ICB).
At HTN Digital Primary Care, we welcomed Dr Minal Bakhai, GP and director for primary care transformation at NHS England, for a discussion on modern general practice, the use of digital tools to improve experiences for patients and staff and the national general practice improvement programme.
We recently had the opportunity to speak to Clare Gallagher, project manager for social prescribing in the Digital First team at NHS North West London ICB.
The Fuller stocktake, published last summer, stated that engagement activities for the purposes of the report “heard very clearly” that the wider primary care team “could be much more effectively harnessed” to support patient access to primary care, with community pharmacy and dentistry noted as particular examples.
HTN Now Digital Primary Care
HTN Digital Primary Care is back, a one-day online event with sessions that explore digital solutions, transformation, and realising a modern general practice.
Join us 27 February for the engaging discussions as we explore the ways in which technology supports primary care, address challenges, and showcase impactful approaches. This inclusive event invites everyone to participate, share thoughts, and exchange experiences on various aspects of digital primary care.
If you would like to join, email: marketing@htn.co.uk
