We do a lot of work with the NHS and other Healthcare organisations and we recently attended the Digital Health Summit, at University of Salford. It inspired so much discussion in the office that I felt I ought to to write some of it down! This is our first article of a series on the subject of ‘Digital Health’.
Patients want to take their health and wellbeing into their own hands. A rapidly growing number of people have found that they can do just that, changing how they are interacting with their primary care facilities. Patients are turning to online services to help them with their health issues and the NHS is using digital technology to bridge the gap between patients and clinical teams.
Patient Online (an NHS England initiative) requires that GP surgeries offer access to repeat prescriptions and appointment booking over the web. The majority of GP practices now offer these services, and plans are underway to expand the offering to include access to patient health records.
The NHS has worked closely with patients, GPs, practice staff, and professional organisations, to ensure that the staff at GP practices have the support they need to promote and use these services in the best way possible. However, to access the services, patients must have a registration letter (a paper print out with log-in details and a password), collected from their doctor’s surgery. Often, this requires standing in a long queue with lots of other people, a flaw in the process which can provide a barrier to all but the most determined patients.
And why are there queues? The nature of ‘general practice’ means the surgeries are covering a lot of bases. GPs are attempting to make things better, but there are problems to overcome, both with processes and public perception. I have observed at our local surgery that whilst patients can check in using a touch screen, not all do. Some patients choose not to, but others have found that not all appointments are covered by the touch screen service. When I enquired as to the reason I was told it was to do with different organisations offering the different services (e.g. maternity services are ‘on a different computer’) which makes sense to the NHS – but not to the patient, who perceives it as one organisation.
Another reason for queues is the simple fact that GP surgeries have limited opening hours.
The Prime Minister’s Challenge Fund was announced in October 2013 to improve patient’s access to general practice. To date there has been £150million funding for pilot schemes across the NHS which has benefitted more than 2500 practises[i] and covers a third of the country.
As well as extending opening times for patients to see their GPs to evening and weekends, part of the challenge has been to improve online services to make it easier for patients to book appointments.
In Leeds West, the fund has already helped the CCG to build upon their Enhanced Access Scheme. This scheme has increased opening hours to GPs surgeries to 12 hours a day, five days a week, as well as 16 surgeries open at weekends too.
Chris Mills, GP and Clinical Lead for Primary Care Transformation at NHS Leeds West CCG said: ‘Our aim is to put patients in control of accessing health care differently and enable clinicians to communicate more effectively with each other.’
The Enhanced Access Scheme is also being used to help develop technology and digital services such as video consultations over Skype (a voice and video calling service which allows people to communicate over the internet). Through GPs integrating their services with the system, remote consultations can be offered at no additional cost to the patient or GP surgery as this software is free to use.
Skype consultations are already being rolled out in parts of the country. The South Devon Healthcare NHS Foundation Trust holds consultations with patients with Skype using their Patient Knows Best portal. This reduces the need for patients to come into the surgery itself, cutting down on potential cross-contamination and allowing patients to see a clinician quickly at a time of their choosing. Clinicians initiate the phone call to allow them to have control over the communication and avoid potential technical issues with incoming calls.
This system helps patients who may otherwise be facing long-distance travel to specialist units and also patients who live in more remote areas, saving travel, time and money. Manchester GP Dr Sirfraz Hussain, who has been offering Skype consultations for over 2 years now, said ‘Communication is mainly non-verbal. You miss out on that on the phone. Skype means you no longer have to miss out on the non-verbal cues.’
However, provision of remote consultations is patchy. Sir Sam Everington, an East London GP, has reported that London GPs are expected to see up to 60 patients a day, and in his opinion Skype consultations could ease the pressure considerably.
However, Skype consultations are just a modern equivalent of the telephone consultations that have been going on for years. Patients are interested in more disruptive services.
The private healthcare market has been quick to take up the baton and offer services to patients who don’t have time to wait for the NHS waiting lists to go down. One such service is the Babylon Health app. Styled as ‘a GP surgery on your smartphone’, the app allows you to ask health-related question with a quick response from a medical professional (essentially a text version of 111 that Babylon GP’s can access later), have video consultations with doctors or specialists, be medically monitored by clinicians, review health records, and more. The app is approved by the NHS and the Care Quality Commission and offers low cost consultations for either £5 per month or a pay-as-you-go rate of £29 per appointment. There’s even a 30 day free trial.
But is it all it seems to be? We trialled it, and despite some technical issues with the app itself, the service is impressive. You can often get a GP consultation within 15 minutes of requesting one, and always the same day. If you need a prescription, it can be sent to a pharmacy of your choice to pick up an hour later (assuming they have the prescribed medicine). I had an issue with this part of the process as there was a bug in the app; however the technical support team were excellent, faxing my prescription through and looking into the bug at the same time.
According to the NHS’s Five Year Forward View, 86% of adults use the internet in Britain but only 2% use it to contact their GP. NHS CCGs and Trusts need to find ways to bridge that gap by providing patients with online services to empower them to be in control of their own care, answering their immediate questions and putting their minds at rest.