For a recent HTN Now panel discussion, we spoke to experts from across the healthcare sector on the future of general practice core systems. This included exploring potential opportunities and areas of future growth, considering challenges such as integration and interoperability, and outlining what “good” looks like in this space.
Our panellists were Bex Cottey, business manager for Conisbrough GPs, Emma Stratful, chief operating officer at OX.DH, Dr Sheikh Mateen Ellahi, GP and practice partner at ELM Tree Surgery and South Stockton Primary Care Network and Dr Shanker Vijayadeva, GP lead, digital transformation for the London region at NHS England.
We kicked off the session by asking our panel: what are some of the biggest limitations with current GP systems? Mateen started by highlighting two of the main limitations which he said were the “user experience and the interface itself” as well as “limited analytic and data capabilities”.
Explaining further, Mateen noted three key focus areas when making the move towards a more modern general practice, including equity and access to care, prevention rather than treatment and using a digital triage system. “But how many practices right now are doing this?” Mateen asked. “Not as many as there should be. And that’s what we need to move towards.” He went on to outline how a lack of predictive analysis within clinical systems “often means clinicians are working reactively rather than proactively” and that one of the best ways to tackle this is by having “more capabilities with regards to collecting good data.” Using an example from his own practice, Mateen highlighted how the introduction of a new telephony system helped with reducing call waiting times from three minutes “down to less than a minute across one whole week of 2,500 calls”. In order to continue to see improvements like this, Mateen added, “what we need to aim for is a modern system that uses AI and machine learning to predict patient conditions based on historical, real-time data, to hopefully enable better patient outcomes.”
Next, Bex spoke about making the switch from one clinical system to another, expressing some of the key limitations her practice found. “We were repeatedly having the system fall down and run slow,” she said. “So the options were to either stop complaining about it and get on with it or change the system.” Because of the limitations posed, the practice ultimately chose to make the switch with Bex adding that “since then the stability of the system has been much better”. Speaking on the wider discussion of which system is best, she added, “the two systems have different features and the features that are the same work in slightly different ways. So, it’s about which system suits you and your priorities best”.
From Shanker’s point of view, he noted how “there is no perfect system at the moment,” and that user needs can vary “from the basics of just getting rid of one extra click to the other extreme of implementing a data flow”. To help tackle this, he suggested making everything very simple, adding how “interfaces have to be easy to use and intuitive, yet also be able to manage a huge range of complexity”.
Emma then talked about how OX.DH has entered the core clinical GP system market via the NHS England Tech Innovation Framework, which she noted was all about “bringing new entrants to the GP market in terms of IT solutions”. Emma continued to outline their OX.gp solution, a modern and intuitive primary care solution, empowering new ways of working to streamline processes and workflows for efficient, patient-centred care.
Aligning with the neighbourhood health model
We then moved on to discuss how primary care systems align with the neighbourhood health model, Mateen noted how “it comes down to population management. You have to look at the neighbourhood as a whole and what their needs are.” To do this, he highlighted the importance of actively engaging with public health while looking at predictive analytics within communities. “It comes down to risk stratification and patient segmentation,” Mateen said, which has reportedly helped to “reduce hospital admissions by 15/20 percent,” according to one study he read. Giving an example, he explained how “some people might be more prone to getting the flu. If you can identify those patients early, you can get them engaged with the flu programme.”
Adding to what Mateen had to say, Emma highlighted her own experience speaking with GPs and how many are “struggling even just to get two screens in a practice or get reliable internet” while being “limited in terms of quality of data and how it’s structured”. In response to this, she highlighted the importance of focusing on the “quality of data” and using tools such as Power BI to run key reports on risk stratification, stating, “if you’re able to analyse and unpick the data that you currently have within your practice, you’re going to be able to better serve your patients at a patient level but also at the local population level.”
Bex echoed the importance of working closely with public health fellows when creating a neighbourhood health model, but also noted a need to consider the voluntary sector and third party “because they are going to be a massive factor in the success of reducing non-medical burden on primary care”. She suggested having a database of “who’s available and where” but also recognised issues with how much of an undertaking this would be, stating, “it’s wonderful to work as a neighbourhood, but I don’t think people quite realise how big that neighbourhood is, even for smaller communities.”
In response to this, Mateen agreed that creating neighbourhood teams would be a “long and difficult project that will take years to properly implement” but also went on to say it was still possible. “Looking at the whole holistic picture is the best way to go forward,” he said, emphasising the importance of using current systems to the best of their abilities in order to help ease the burden. He referenced statistics from the RCGP, saying, “there’s been a 10 to 15 percent increase in appointments from pre Covid to now” and how “more and more GPs are leaving the profession,” so the best thing to do is to continue looking for new solutions and also “find the best way to use current solutions”.
Overcoming barriers to implementing change within systems
Shanker outlined some of the barriers to changing systems, including the frustrations around retraining and data migration. He noted how clinicians tend to be “really frustrated by our systems but actually a relatively low proportion of us have the capacity to go through the upheaval to make the change.” He added that key motivations to actually making the switch to a different system often come as a result of “system crashes and the level of functionality being offered by current systems”. However, he also said that when it comes down to it, “it’s all about your mindset. Even if you’ve got that backend functionality, if you think it’s not easy to navigate or it’s clunky, there will still be limitations”.
Bex added that data silos across the NHS were another key barrier, highlighting how “interoperability has to be key” to improving these systems. “We’re not maximising the use of our clinical facilities,” she said, before suggesting how “it may be that we’re not even aware of what’s available to us or that we’re waiting for it be available. Or it’s just so far ahead of the curve that we can’t wrap our heads around it.”
From a supplier perspective, Emma noted how “GPs will utilise existing systems differently, finding workarounds which can affect the quality of data”. To combat this barrier, Emma emphasised the importance of directing GPs “down the same path” and trying to keep systems “simple and consistent so that we’ve actually got something really meaningful to work with to better support patients.”
Using AI to improve systems
Shanker then brought up the use of AI, noting the “quick wins with workload reduction and clinical decision making” when using AI in these settings. Bex outlined some resistance around this, noting, “half of us are miles ahead thinking how can we use ambient AI to make our clinical systems work better for ourselves. But there’s also this fear that AI is going to make the system even messier rather than more coherent. And I think that’s where we’ll see a lot of resistance in primary care.”
She went on to explain where this hesitation might have come from, adding, “there are practices out there, ours included, still with cupboards and cupboards of paper records. We were told years ago that a system would digitise all those records, but in areas without the funding, that system never materialised”. She highlighted how “the burden of maintenance” seems to always fall on general practice but “we’re not fully supported financially or otherwise to really get on top of that”.
Opportunities for general practice
When discussing some short-term opportunities for general practice, Mateen emphasised the need to enhance the capabilities of current systems. “We always talk about new initiatives and ambient AI etc.,” he said. “But there’s a simple solution, in my opinion: why can’t we clear the space taken up by professional records?” He mentioned how this has already been achieved by many practices in London but that northern practices sometimes get “left behind”. Mateen also outlined the importance of understanding demand and capacity, enhancing digital access and streamlining the triage and care navigation processes.
For Shanker, it was all about strategy. He noted, “we need a good strategy like we had with electronic prescription services, but we also need to think about those times when we implemented something that was solely driven by addressing a user need”. As an example, Shanker spoke about ambient AI as something that “wasn’t part of a wider strategy but took off because it was agile and fixed a problem”. Shanker also highlighted how “not all clinicians are system thinkers and user experts, so we can’t always communicate our frustrations in a way that will help an IT company work out what the fix should be”. He suggested an opportunity here would be to have a “combination of clinical and user experts to drive some of that change at the bottom end”.
Offering input from the supplier point of view, Emma then explained how OX.DH has been working with a practice in the north of England who have been “very much involved in that UI and that testing,” but also noted how “a GP elsewhere might want something different”. Despite the difficulties of trying to tick every box for each of the seven and a half thousand GP practices, Emma explained how OX.DH instead focuses on building a system that “ticks the majority of boxes and can then be modified to tick other boxes”. She added, “the more insight we get into GP practices and the challenges they face, the more we can make a solution that’s going to be fit for the future”.
Key learnings and areas of focus for the future of digital practice
Finally, our expert panel spoke about the key learnings from implementing digital solutions in their own practices, with Bex emphasising the importance of time. She explained how it took her practice 12 weeks to switch from one system to another and despite being a “lengthy process,” it was necessary for getting it right. “We needed that time to check every step of the way and even now, a few years on, we’ve not found any gaping holes of incidents which is testament to the process,” she said.
Bex went on to add that finance was also key, at both practice level and ICB level, stating, “it takes a lot of staff and a lot of money to set things up and there’s this insecurity as to whether the funding is going to be recurrent or not.” In order to tackle that insecurity, Bex suggested, having more “long-term investment, not just for this year or even for the next five years, but long into the future”.
Wrapping things up, Mateen expressed his optimism for agile practice as a whole, stating that in his experience, successful integration comes down to three key elements. The first one he outlined was collaboration with key stakeholders, which he said needs to be done “prior to accepting any contracts” and include “everyone who’s going to be using the systems,” otherwise adoption “will not be successful”. The second key area to focus on was effective training on all new tools to “make sure they’re being fully utilised within the practice”. And the last thing Mateen mentioned as being essential for successful adoption was a phased rollout of pilots with continuous celebration of “quick wins” such as patient satisfaction results, staff survey results or just having a good day overall.
We’d like to thank our panel of experts for joining us for this insightful panel discussion. If you’re interested in getting involved in the conversation, check out our upcoming events.
