We sat down for a chat with Dr Osman Bhatti, GP and chief clinical information officer at North East London ICB, to catch up on programmes and priorities from the region. Osman kindly shared with us some of the progress updates and insights from NE London.
Access to patient records: progress and challenges
We started out by asking Osman about progress on improving patient access to medical records.
Osman said: “It’s been an interesting roll-out. I think the concern is still around how we protect patients who may have issues relating to safeguarding or domestic abuse, and so on. There are competency or capacity issues we need to be mindful of. If we are allowing automatic access, it’s a question of whether it’s those patients getting the record, or whether it is somebody else getting the record on their behalf. In some cases, that may not be appropriate. There’s been lots of discussions around how best to protect patients; it’s something that practices need to ensure they have in mind when they include information in people’s records. I think that’s going to be the key challenge going forward – making sure that we are marking records if they contain sensitive information so that it isn’t visible online.”
How are staff finding the roll-out? “I think the whole process has been rushed through a bit from the national angle,” Osman reflected, “and that’s been the concern generally. It’s an ongoing process, and primary care is under a lot of stress from different angles anyway. The main focus is very much on trying to ensure that anybody new coming in – locums, and so on – are aware of the processes in place for access to patient records.”
Digital First programme
Osman discussed some of the projects that he has been involved in through the Digital First programme, which focused on understanding challenges and inefficiencies in existing care pathways with a view to improve them through use of digital or pathway revision.
Firstly, he shared insight into the breadth of the projects involved. “We’ve done the online consultation, or video consultation rollout; there’s been a big focus on GP record access, and we’ve been commended for our facilitation. For a lot of tools that have been rolled out across the patch, we’ve ensured their standardisation, so that all the data going in is the same and therefore we can get good data coming out.
“We’ve invested quite heavily with the Digital First programme on people. That’s key – ensuring that we have got facilitators who can go in and essentially handhold practices through different processes, using the right templates and using things like Microsoft Teams, which has been used as a collaborative tool across multidisciplinary teams.”
Osman continued: “We’ve done a lot of work around online registrations, which is being copied into the national programme; we’ve also done a bit of work around the NHS App and ensured that that’s the app of choice across NE London to use as a front door. We’ve built on that, so it can be used for online consultations and ordering prescriptions, and we’re building care plans on the back of it, which is still ongoing through the Patients Know Best portal.”
In addition, Osman shared how there has been a focus on delivering consistent website standards; the developing of an online portal for primary care staff so that they can find information with ease; work on capacity; and work on care homes. “One of the biggest benefits of the care home project is that we’ve got a lot of care homes that have complied with the DSP toolkit,” he shared, “and we’ve also done a lot of work with social prescribing, rolling out digital tools for that. That’s just off the top of my head, there’s a lot more!”
Regarding his learnings from the Digital First programme, Osman answered: “It’s been a really good journey, and a lot of it has very much been a team effort. It’s been made easier by the fact that we’ve got a great digital team of clinicians who’ve been clinically leading projects, managerial support and project managers who’ve been really on the ball in terms of making sure things get rolled out properly. It’s made it a lot easier than it could have been. Teamwork, collaboration, everybody wanting to achieve together – they’ve been really positive. Having a monthly catch-up on all of the projects involved was a good idea, and I think we’ve achieved a lot over the last five years which has been a testament to the team.”
Reflections and looking ahead
We asked Osman if there are any digital projects he is particularly proud of from the last year.
He raised the progress around online registrations and the fact that it was taken on as a national scheme, along with the support around online consultations which he said is a “testament to the great managerial and clinical leadership”. He explained: “One of the biggest problems was that we had one tool in North East London, and not all practices were using it. So we came up with a procurement process where we had three tools available and practices could use one of three. That worked really well.”
“Facilitation, I think, has been a key aspect of all of these things; looking at supporting practices to get tools rolled-out. We’ve done a lot of quality improvement work to go into practices and really facilitate things to last.”
Opportunities for digital health in primary care for 2024 and beyond
“I think we need to push for more collaborative working, and work around e-hubs,” Osman said. “How we do things consistently with collaborative working across a PCN? Something we’re going to hopefully keep going forwards is the fact that if we offer something for one practice in North East London, all practices get it; so there’s some equality of access. With e-hubs, for the next year we have given all of our practices the same offer; so all practices who belong to a PCN can have access to working together through EMIS clinical services, and they all get the same standard of configuration. Whether they are ordering investigations, doing spine services or doing prescriptions, anything that can be done at one practice can be done across the PCN.”
He also noted that there is a focus for the future on Patient Knows Best and building care plans into the NHS App, along with building on existing learnings around demand and capacity.
“The other thing going forward is related to the staffing issue,” Osman said. “It’s the question of how we utilise our staff better. Remote working, I think, is going to increase in the year ahead.”
Are there any areas of digital potential within primary care that NHSE isn’t making the most of at present?
“I think it’s recurrent investment,” he said. “Presently, a lot of funding is just for a year, but there’s no recurrent funding. I think that’s going to be the key. How do we invest to save in an effective manner? That’s going to be the challenge.
“It is getting the basics right; I think we always start jumping up and down for the latest automation solution, which sometimes isn’t all that helpful. We need to look at the foundational elements like network infrastructure; do we have good wi-fi? Do we have double monitors on all screens? There’s no point having a fancy tool if you can’t switch the PC on to use it.”
If Osman could solve one problem or challenge for digital primary care, it would be…
“Increasing the number of GPs. There’s a lot of investment into other roles which is welcome, but fundamentally, successive governments have promised more GPs, and we’ve got less. That’s putting a strain on us.”
Apart from that, he said, he would like to enable more remote working, to support existing staff with their ways of working and work-life balance.
What are you most excited about for the future of digital healthcare?
“I’m most excited about the potential that can come about from working collaboratively across e-hubs,” replied Osman. “I think that’s going to be an exciting project that we can then build on, so you can potentially get neighbouring hubs to work together on federation level or wider.
“I’m excited about patient access to medical records – but doing it safely is key.”
Another project that Osman noted is the London Data Service. “This is really exciting; but again, it needs to be done in a controlled way to ensure that people accessing the data are the people who the data is for,” he said. “Also, we need to ensure that we’ve got good access, not just within our healthcare system, but also the wider team. Pharmacies, dentists, opthamologists, opticians – it’s that kind of sharing I think we need to improve on as well.”
We would like to thank Osman for his time, and for sharing these insights with us.
From our industry view piece back in October, we spoke with Osman and three other representatives from ICSs, on digital priorities in their region – and what they are looking forward to in the future with regards to digital in health.
