It has been nearly four years since my post in relation to the NHS long term plan and in this time, we have witnessed a pandemic of biblical proportions, I personally have been diagnosed and am managing a chronic condition and digital health has accelerated in growth to try to support the ever-increasing demand on our health service.
In my previous post I spoke about the different initiatives that have been put in place by governments to address the issues at hand. Now we have established the Integrated Care Systems (ICS) which have been introduced across NHSE to bring primary, social, and secondary care together in collaboration. This move is not without its problems and still needs to be embedded successfully.
The NHS Long Term Plani was published in January 2019 following the Five Year Forward Plan which focuses on the strategy for maintaining and improving the services provided to the population with detail on the approach and main areas of focus. I have taken the opportunity to look at two specific aspects of the plan in relation to primary care.
Chapter One considers the need for joined up care at the right time where patients will get more options. With the focus being on GP practices and the need for digital maturity to become second to none in our surgeries.
We now have initiatives such as the DFOCVC framework for virtual consultationii to provide a means to access consultations from our smart phones and devices allowing for more flexibility and choice which proved priceless during the COVID pandemic. On reflection, has this become the mandated choice for GP surgeries due to increased numbers which has seen the face-to-face (F2F) appointment become a luxury for the majority.
The argument that most previous F2F appointments could have been avoided is true in a lot of cases, but experience suggests that there may be many patients with chronic conditions that haven’t seen a GP or Consultant for months if not over a year.
‘Patients echo some of these concerns. A survey undertaken during the pandemic in the UK found that patients understood the need to provide care remotely and have tried to minimise demands on the NHS. However, the majority share the perception of health care professionals that the system should not permanently switch to remote by default and that remote consultations are most suitable in situations where the problem is relatively simple. More than two thirds of patients (68%) have concerns that their health professional would not be able to assess them appropriately remotely.’iii
There are concerns that online consultation becomes the method of choice. This has the potential to exclude those individuals that do not have access to digital technology or are lacking in the appropriate digital skillsiv. However, the benefits far outweigh the risks which mostly can be mitigated through the introduction of process change and training.
This will allow patients to have the choice of online consultations with the creation of truly integrated teams that will include GPs, social care, and community health teams. This should reduce the burden on acute services allowing growth in this area to provide better outcomes for those admitted with critical illnesses.
New technologies such as wearables which link to personal health records are an essential part of the roadmap in support of the digital transformation in primary care. As supporting the patient in their own home becomes more important to help reduce hospitalisation rates and re-admission.
The patient taking control and ownership of their health record is becoming a reality with several solutions available that offer several different ways to view either health specific records or combine this with personal information. This makes it more of a holistic experience for those who will embrace this as a solution. Incorporating features into this technology that advise and support the user with choices and health promotion using their health data will go some way in creating a healthier nation.
Chapter Two concentrates on health prevention as a key message to promote a healthier population and make sure that there is an emphasis on those comorbidities that have put an increasing pressure on services in previous years. Health promotion plays a big part in improving care and enhancing preventative medicines where mobile technologies and AI could influence change.
A learnt process that could inform on risk factors and markers would help advance management of conditions and their prevention at source. This is already evident in the work being done by many digital health manufacturers in the market.
There are many opportunities for GPs and Consultants alike to recommend mobile technologies to their patients that can help them in the management of existing conditions and to maximise the opportunity to lead a healthier lifestyle. There is a plethora of mobile applications that assist in the management or prevention of numerous conditions and diagnoses, but it is of extreme importance that they are policed and reviewed making sure they are ultimately safe to use and of some benefit to the patient and clinicians alike.
This emphasises the need to educate digital health manufacturers and Health Organisations in the NHS safety standardsv, Medical Device Regulationsvi and the many other compliances that are essential when bringing technically challenging solutions to the health sector.
With the adoption of Integrated Care Systems (ICSs) to improve services by the management of resources there is a need to provide better and more joined up care for patients. This requires primary, social, and secondary health services to be intrinsically linked in their approach especially with the implementation of digital health systems. The use of information and data within the NHS is key to the success of the ICSs and should be the driving force to improving and transforming digital health in the NHS to a point where it becomes second nature to access and manage your personal health record from your chosen device. Allowing patients and clinicians to interact in such a way that is seamless in its application.
A piece of research undertaken in 2019 identified that there were 44% of NHS Trusts who do not have a digital transformation plan at presentvii. Fast forward four years and at present, only 20% of NHS organisations are digitally mature, although 86% have a form of EPR in place. Only 45% of social care providers have any form of digital care recordsviii. This is a worry for the ongoing implementation of the long-term plan and should be looked at as a priority by NHS England in the continued improvement of the IT infrastructure of the NHS. I am aware that this is only one part of a bigger picture when creating ICSs but should be considered as having a major impact on their success.
The next instalment will look at further chapters and the influence that AI can have on patient care plans and the clinical safety implications for its introduction into digital health systems to support both clinicians and patients alike.
References
i NHS England (2019) The NHS Long Term Plan
ii NHS England (2021) Digital first primary care
iii Britain Thinks. Britain thinks: patients and public 2021. https://britainthinks.com/wp- content/uploads/2021/03/Richmond-Group_Phase-2-full-report_FINAL-30.03.21.pdf, https://britainthinks.com/wp-content/uploads/2021/03/Richmond-Group_Phase-2-full-report_FINAL- 30.03.21.pdf.
iv Unintended consequences of online consultations: a qualitative study in UK primary care Andrew Turner, Rebecca Morris, Dylan Rakhra, Fiona Stevenson, Lorraine McDonagh, Fiona Hamilton, Helen Atherton, Michelle Farr, Sarah Blake, Jon Banks, Gemma Lasseter, Sue Ziebland, Emma Hyde, John Powell, and Jeremy Horwood British Journal of General Practice 2022; 72 (715): e128-e137
v DCB0129 Clinical Risk Management – its Application in the Manufacturer of Health IT Systems DCB0160 Clinical Risk Management – its Application in the Deployment and Use of Health IT Systems
vi The Medical Devices Regulations 2002
vii Nearly half of NHS acute Trusts ‘do not have a transformation plan’ CSJ MAR 07, 2019
viii A plan for digital health and social care – GOV.UK 29 June 202
