How can digital technology support a future NHS?
by Tobias Alpsten, CEO of Health Tech specialist iPLATO (www.iPlato.net)
NHS Chief Executive Simon Stevens this year unveiled new plans to provide millions of patients with quicker access to health apps. Stevens believes smartphones to be one of the ‘most powerful diagnostic tools now available’ and is hopeful that people already embracing apps including Airbnb would show the same willingness to embrace digital health technology which would help improve care and save the NHS money.
In response to this strategy iPLATO recently launched a new app – myGP™ – to help patients in England access health services through their smartphone. Integrated with the National Health Service, myGP allows patients to book GP and practice nurse appointments around the clock. Free to patients and surgeries myGP works with all three major GP principal systems in the UK – EMIS, Vision and SystmOne. So far, we have enabled the service for the patients in 250 GP surgeries.
Research shows us that no other electronic channel elicits replies as quickly as SMS messaging, in fact, 53%1 of people respond to a phone message within 60 minutes and 8 out of 10 people aged between 65-74 years of age own a mobile device2. This data points to a digital revolution and, in particular, mobile technology has transformed the way we all live our lives. But what are the barriers to NHS adoption of such services, which can help save money as well as improve and support a more patient-centric approach to care?
In our experience, improving access to GP services has proven popular with patients. myGP has been the most downloaded medical app in the UK since October. Transaction volumes are soaring. In November iPLATO helped patients book or cancel almost 45,000 appointments using the app or, for those without a smartphone, via text message. Patients are ready for digital healthcare.
Unsurprisingly perhaps, transformed access to publicly funded healthcare services (free to patients) has its challenges. Due to the mismatch between smartphone usage and healthcare needs, some GPs worry that the wrong patients book the wrong appointments. Clinicians’ issues are real and we must welcome their constructive criticism. For us working in Health Tech, it is our job to address this and other issues related to demand management and business process.
Technology delivering patient-centric care
In the last 5 years, the number of GP consultations has increased by 23% while the number of fulltime GPs has flatlined. Furthermore, in the last two years, the time between a patient booking a GP appointment and attending the surgery has increased on average to 13 days3.
NHS commissioners are looking for is video consultation to address the scalability issue in primary care. Alongside other providers, iPLATO will launch a video consultation service in the first half of 2017. Previously, unless you were lucky enough to be part of an NHS trial, you could only get access to primary care services via video on your phone by ‘going private’.
Pushing patients to private primary care providers just because of their technology edge will increase health inequalities, fragment the system and destabilise the NHS workforce.
If adopted across the NHS, remote GP services could allow patients to access care 24/7 from anywhere through video consultation. However, of course, this type of capability will put further pressure on the system as it will be even easier and more convenient to see a doctor.
To respond to the challenge of demand management we will work with our NHS partners to introduce intelligent triage to help our existing network of GPs respond the emerging patient requirements, manage demand and offer professional and safe remote care services.
In addition to triage we are testing a range of ideas for streamlining preventative interventions.
- Stop smoking. This feature allows practices to automatically requests patient smoking status and, if relevant, sign-posts local stop smoking services. In addition to supporting patients to make and maintain healthier lifestyle choices it enhances practice revenue through a bonus system called the Quality of Outcomes Framework (QOF).
- Winter flu immunisation. This winter, GP surgeries have been able to use digital appointment booking technology to launch their winter flu immunisation programmes via myGP. The push to improve immunisation uptake will benefit GP surgeries, with an additional £9.80 per jab (amongst those ‘at-risk’ patients)4 as well as each surgery earning a potential extra £3,000 from QOF5.
- Child health. Since October parents can register their children under 12 on myGP. and initial figures show promising results. Parents added 3,523 children over a 6 week period7. The aim for the future is to enable patients to add other relatives to the service, for example, elderly family members living with long-term conditions.
These features have proven popular among practices and patients. In the new year, we are linking this capability to community and secondary care services to support ‘integrated care pathways’.
Professor Keith McNeil, Chief Clinical Information Officer at NHS England, reinforces the need for such services; “Digital innovation has the power to directly enhance patient care, improve the sustainability of our systems and transform the way people access NHS services and manage their own health.”
Improving adherence to medication and reduce waste
Another area of enormous potential is prescription medicines and, in particular, medicines optimisation to help patient achieve maximal health benefits from prescribed medication and to reduce waste in processing the 1 billion prescriptions that the NHS generates every year.
Broad, patient-led improved adherence to prescribed medication could have a significant impact on commissioning from both an outcomes and cost management perspective. Digital solutions and health apps promoting a patient-centric approach can help tackle the widespread issue of poor medication adherence.
Wasted medication is estimated to costs the NHS £300 million each year6 with up to 50% of people not taking their medication correctly. In the EU alone nearly 200,000 deaths occur per year because of missed doses of medication.7 Currently, there are five million patients in the UK that take four or more medications. We will reduce some of this waste by digitalising prescription ordering.
We must never forget that behind these startling facts lie thousands of family tragedies. If a fraction of the cost to better manage medication was invested in new innovative technology and intervention services, the NHS could save millions of pounds and potentially lives every year.
Reducing pressures on hospital care
To reduce pressure on healthcare myGP offers a range of patient self care support tools including medication management and the ability to keep track of vital signs such as blood pressure alongside sophisticated demand management tools for the GP to select patients based on clinical risk and invite them to specific preventative services – for example flu jab or stop smoking. These features are all intended to help patients stay away from the GP or hospital consultation room.
According to the NHS Patient Survey8, on average one in ten patients who do not get acceptable access to primary care attend urgent care services such as A&E – at a significantly higher cost to the nation. Transforming access to primary care offers obvious advantages to patients but it benefits commissioners and tax payers too.
As such, there is a nation-wide push to ensure that the majority of GP appointments are used effectively to help reduce the burden on urgent care services. Using the myGP or text messaging to cancel, patients systematically free up urgent GP appointments and helps to reduce the number of appointments marked as ‘Did Not Attend’.
As a healthcare community, we need to work collaboratively and appreciate that digital patient-facing technology may well be the answer to saving our much-loved NHS.
Overcoming cultural barriers
There is still a widespread nervousness within the NHS that digital innovations are seen to be as nice to have ‘add-ons’ and the sector falls behind other industries in its adoption of digital technology and innovative solutions.
The reality is healthcare is late to the digital party. Today, less than 5% of primary care transactions such as appointment bookings are digital, whilst almost 50% of consumer banking transactions and 80% of travel bookings are online. We have a steep mountain to climb and it is getting steeper. Change is inevitable and the winners will be those who choose to lead rather than follow.
The NHS is backed by ancient and complex funding models and procurement issues; patient-facing digital innovations are part of the NHS ‘service delivery’ and not capital investment of IT hardware. With fragmented pools of funding, innovations which are unable to deliver cost-savings within a required time-frame promote short-term rather than long-term strategic solutions.
For organisations to really embrace innovation and new creative advances they need to break down barriers, let go and refrain from dictating the minutia, and instead, focus on the essential criteria, in this instance – patient safety and improved outcomes.
Ultimately, if we are to drive real cost savings and efficiencies within the NHS, digital solutions need to sit at the very heart of service delivery and long-term strategy. While taking clinician views into account and ensuring safety, the focus should be on delivering what patients want and letting patients decide what they want to use. However, the question still lies as to why this is not happening, perhaps fear and a lack of trust plays a role in the reticence to embrace such technologies?
From the perspective of doctors and nurses working or considering a career in primary care, the good news is that the need for generalist expertise is likely to grow. Digitalisation of some services also offers unparalleled innovation opportunities for clinicians, so it seems unlikely that the profession will suffer from an accelerated adoption of new tools and processes.
There is no doubt that digital technology can and will help transform healthcare. The patients are ready. Although (rightly) sceptical to hype clinicians are receptive to safe and secure digital ideas that make their life easier. The tech is ready. Now, it is just a matter of when.
- NWIS June 2016
- Ofcom 2016
- Pulse Magazine: Poll of 831 conducted by Pulse
- Omnicell UK 2015
- NHS Patient Survey: 2014