Panel discussion: digital primary care “Small incremental steps will lead to bigger and better changes”

We were recently joined by Liz Leggott (project manager, greener NHS champion and NHS England clinical entrepreneur at the South Yorkshire Primary Care Workforce & Training Hub) and Emma Stratful (chief operating officer at OX.DH) for a discussion on digital primary care. 

Liz and Emma discussed a range of topics, from the projects they have been involved with to challenges in this space and the role of innovation in primary care. 

We began by asking our panellists to offer a brief introduction to themselves and their role. Liz kicked us off, sharing how her team at South Yorkshire Primary Care Workforce & Training Hub have been considering the ways they could potentially get their workforce up to date with digital skills. 

“I used my practice manager background, my facilities background, and my project manager background, to try and find out what we need to do as a hub to get us to a point where we are digitally adept,” she said. “We’re doing some good quality training, and we’re hitting the targets of the long-term workforce plan – it’s exciting work, and I’m happy that I can do it.” 

At OX.DH, Emma has been working on building digital health infrastructure, with the company starting out in assisted reproduction space and developing an end-to-end clinical solution to support the workflow for both clinical staff and patients. This was then adapted to create, a GP foundation solution. 

“We are part of the NHS tech innovation framework, so we’re working very closely with NHS England to develop the next generation of primary care infrastructure,” said Emma. “We are integrating extensively across the NHS ecosystem, looking at e-referrals, prescribing, and integrating with summary care records GP to GP. At the moment we’re focusing on interoperability, a primary care challenge we’re addressing.” 

Health tech for primary care in practice 

Liz shared how her organisation has utilised virtual reality to help reception staff deal with challenging situations, such as cases where a patient might have got agitated or angry. “It involves a body-swap piece of software with a virtual reality headset, whereby users can go through different scenarios on a given topic. There is a patient avatar that has been programmed to give you signals that you need to react to. For example, there’s one on body language; if someone is getting anxious or angry, how are you going to calm them down? There’s another about recognising your own anxiety and how you are reacting to this patient, so that one focuses on breathing techniques and centring yourself.” 

When they first tried out this software, Liz continued, only about 50 percent of the group wanted to have a go. “We assumed they’d be excited to try it out – so that was an example of needing to rethink how we approached it. The next time we did it, we tried a different topic but used the same software and we had a 95 percent uptake. I think sometimes it is about having a little more exposure, and also every time we do something, we learn something different. 

“We’re now trying to get a game on the headset, so if somebody is still new to a headset they can get used to it by just doing a very simple action on a game, on an app. Sometimes the headsets don’t suit everybody, and people might get motion sickness, so we need to make sure we’ve got a different method of access for them; same software, same experience, just a different way of accessing it.” 

Emma picked up on the point about patient frustration, acknowledging that dealing with this can be challenging for staff. She noted that technology needs to enable workflows that will support those on the frontline, and grant access for patients through digital means before they get into the practice. 

“There are online tools you can use to answer questions that patients might have, and tools that can support practices in looking after cohorts of patients with long-term conditions, sending patient-reported outcomes measures via text message and then feeding that information back to the practice, for example those with respiratory disease. It’s really looking into where those peaks in demand are in a practice, and having the technology there to support it, making things easier and more streamlined, so staff don’t have to log into numerous different systems to be able to look at one patient view.” 

Liz considered that in the future there would be space for doing something like this with patient wearable tech, feeding information back into the system and making it easier for practices to manage long-term conditions, saying, “I’d love to see something like that added in, so we’ll see”. 

Challenges in the digital primary care space 

Discussing some of the challenges in the digital primary care space, Emma mentioned issues relating to tech and integration, as well as the need for testing and validation for new technologies. 

“If we can get through that challenge, then there’s the issue of deployment,” she stated. “If practices have been using the same technology for 20 years, it’s a sea change for them, and that can be difficult. We are trying to make that transition easier. There needs to be buy-in from practices that are already under so many constraints and resource limitations, so it has to be done in collaboration, helping people to understand the benefits.” 

Liz agreed that culture change was often difficult to achieve, but that “if we’re using that technology and it becomes everyday, then we hope that that will transfer across to any other piece of technology that comes their way”. She also highlighted the challenges with meeting the long-term workforce plan, particularly around overcrowding and with new roles coming in which “have to sit somewhere”, adding more pressure to primary care. 

“One of the things we’re looking at around technology is how we can create a virtual nurse placement,” Liz shared. “We were aiming for 70 – 80 percent of the placement to be digital, and the rest of it to be face-to-face. It’s not about simulated hours; those are different to virtual reality. That’s another challenge around terminology – it can be difficult explaining to someone exactly what it is we will be doing, and how it ticks boxes for primary care.” 

The role of ICBs and PCNs in supporting digital transformation 

On the role of ICBs and PCNs in supporting digital transformation, Emma highlighted that ICBs are still relatively new and finding their feet, meaning there are “still some challenges around getting buy-in across the whole of the region, and in aligning purchasing power”. 

She continued: “Are you buying technology for the whole of the ICB, when not everybody wants it? You’ve got a mix of services across different regions and there are may be boundaries in terms of delivery of care. From an outsider’s perspective, ICBs in general can be very difficult to understand, because they all operate slightly differently. How they assess and procure is quite challenging, too; in theory ICBs can pick things up and decide to give it a go and pilot something – but again, piloting comes back to an issue of resourcing.” 

Liz agreed, adding that governance around different suppliers can be challenging. She noted that when she had first started, it was difficult to know where to start because there were so many suppliers wanting to work with the NHS. 

On the South Yorkshire region, she continued, there is a chief clinical information officer in place, and some of the PCNs have a digital transformation lead. “There’s work beginning to happen in this area – but again, it comes back to the teaching of digital skills and the acceptance of this new technology. What’s where the hub has a role to play. We were given some funding from Health Education England to bring in technology, to figure out what we needed and do some testing and research. With that, we’ve managed to implement quite a lot of these new technologies into our training.” 

Training and upskilling staff to be confident using digital tools 

Coming back to the training and upskilling of staff to be confident in using digital tools, Liz said that the hub is “still in the early days” of fitting the technology around its existing training, but the VR training for GP receptionists is a good example of this work in progress. 

Liz also mentioned that often with instilling confidence in digital tools and skills, “it’s just the offer of that psychologically safe space to make a mistake”, where staff can practice as much as necessary to get their confidence and capabilities up. 

Emma mentioned the disconnect between how confident people tend to be with using technology in their everyday lives, quoting ONS statistics that say that more than 90 percent of people are internet users, and 80 percent of people do their shopping and banking online; but when you look at healthcare, the numbers are comparably small. 

“You’ve got things like the NHS App, which we used beautifully during COVID to get access to vaccine information and so on – but actually it’s so variable in terms of what GP practices will publish,” she said. “Some patients are more savvy than others, and the same happens with staff. There is a real need to support people who are less confident.” 

OX.DH provides sandbox environments, she continued, so that people can test themselves with fictitious patients and get used to the system. “It’s about trying to make it easier for users; so actually, you can’t hit the wrong button if the wrong button isn’t there, and you can’t undertake activities that perhaps your job role doesn’t allow you to do.  That role access is a safety net for staff, because then they know they can’t perform actions that would potentially cause problems.” 

Emma also highlighted the importance of having champions within a practice, that can help around the training of staff, which she said was something that had been successfully used to support training in OX.DH’s video consultation solution. 

The future of digital in primary care  

As the panel drew to a close, we asked Emma and Liz what they thought that “good” looked like in digital primary care, and what they would like to see happen within the next 12 months. Emma shared her supplier perspective, saying: “As an innovator of primary care technology in terms of a foundation solution, I would like to see the new entrants on the tech innovation framework really be supported to be able to provide choice within GP practices. Funding is available to support practices or PCNs to look and explore options with particular suppliers, and there’s additional funding for pre-deployment – this is ‘try before you buy’. 

“I would like to see more engagement potentially from GPs, just in terms of how we can help, how we can use workflow management to alleviate some of that pressure,” she added, “and also how we can tackle interoperability across the whole of the NHS ecosystem, bringing solutions into one place so you’re not logging onto a number of different systems.” 

Liz talked about her overarching goal being the development of a technology-led training and simulation centre, saying that funding was an issue in terms of realising this, but that she would consider doing this in smaller bits if she needed to in order to get that technology into training. 

“We’ve realised there is a need for a simulation technician/educator apprenticeship or something similar, and some new support roles for within the hub. So it may be that we’d like to look at how we start that, how we roll that training out.” 

She continued: “The people that we’ve now got on our preceptorship roles are landing in primary care, and they will be playing a role in helping to realise the role of tech in primary care, because they’ve trained using it.” 

Regarding the long-term workforce plan, Liz noted that she would “like to prove that we could do things differently with a focus on being innovative in the way we deliver stuff – so we can increase capacity and we can get economies of scale.” 

Looking further ahead to the next 10 years, Liz shared that she has been in conversation with NHS England’s blueprinting team, to see whether the hub could look at being a national innovation centre, as well as widening that offer out to community services and social care. 

“There are people working in social care that need the same training that we give our nurses; why is that barrier there? It’s generally down to funding, so it’s about having that integration. There are some integrated academies popping up, and they’re really on the right lines, and I think if we follow that model but with technology, we could have the gold star standard.” 

Emma shared that she would like to see an increased focus on streamlining some of the procurement processes and the frameworks, “because we’re moving into a new era where suppliers are providing technology that covers more than one element, so it’s not just about workflow or referrals, it’s the whole package”. 

“I think the tech innovation framework has really opened our eyes on that, and the challenges in terms of enabling the different subject matter experts within the NHS to see that bigger picture. I think there are challenges ahead; the workforce issue is an issue, but if we’re still trying to use old technology then we’re not going to improve. Small incremental steps will lead to bigger and better changes, but we’ve got to start taking those small steps to start with.” 

We’d like to thank Emma and Liz for sharing their insights with us on this topic.