New technologies will not be the panacea for all things supposedly inefficient and bureaucratic in general practice. But when implemented methodically, digital innovation can assist GPs to deliver consistent, high quality and accessible care, at a time when unsustainable workloads and resource constraints are putting pressure on services.
At our recent GP Learning Network meeting, our members shared their organisations’ experiences with adopting new technology to tackle the challenges they are facing.
We heard about three ways that GPs are working with digital innovation to create better care for their patients:
1. Managing the demand for access
From 2012, the GP Patient Survey has shown a year-on-year rise in the number of patients reporting difficulties getting through to their practice on the phone and longer waits for routine appointments. On the other side of the surgery wall, we hear GP anecdotes about the challenges of meeting rising patient demand; not all queries necessitate a clinical face-to-face or telephone interaction. Many surgeries have adopted methods of triaging appointment and phone call queries to try to divert demand at the earliest opportunity. These methods range from training up receptionists to determine what needs escalating to a clinician, to a ‘doctor first’ approach, with GPs triaging all phone calls coming into the surgery.
The Hurley Group has sought to tackle demand pressures by designing an IT system to exploit today’s ubiquitous use of email and the internet. WebGP is a software program which integrates with their surgeries’ websites, offering patients access to a range of digital options: ‘symptom sorters’, self-help guides, medical sign posting, and E-consults (clinical queries emailed to GPs for triaging).
WebGP aims to safely divert clinical queries before they reach a GP, and preliminary data suggests it does. According to Hurley's own data, 60 per cent of 1,600 E-consults were completed without face-to-face consultations, saving an estimated 400 GP hours. A feedback survey found 79 per cent of patients would have requested a GP appointment without WebGP whilst three per cent would have done nothing, countering the suggestion that this system induces demand.
2. Enhancing patient safety and continuity of care in the community
Caring for complex, immobile patients in the community is an enduring policy focus. These patients are vulnerable to protracted hospital admissions, which, paradoxically, often begin as simple problems which have escalated before a GP has been able to see the patient at home.
Whitstable Medical Practice, a multi-speciality community provider (MCP) vanguard, has piloted a new approach to combat this – bringing together mobile technology with professionals possessing untapped or underused clinical skills and experience. Six paramedic practitioners deliver a home visiting service during GP surgery hours. All home visits are triaged by a GP. The practitioners carry an iPad tablet with EmisWeb, giving them access to electronic medical records, including secondary care correspondence, medication lists and test results. They can correspond with GPs real-time through EmisWeb messaging, collaborating on management plans during surgery hours; and access to medical records mean clinical notes can be entered contemporaneously.
With real-time communication, Whitstable are exploring the potential value, and governance requirements, around securely sending GPs images of conditions, such as skin rashes or using videos to share evidence of symptoms, for example with respiratory distress in COPD patients.
Whilst the project is its infancy – with 75 visits to date – there has been 100 per cent positive patient satisfaction. An estimated 70 per cent of hospital admissions have also been averted from patient homes or care homes (this figure is drawn from asking all patients or carers if they would have called 999 in the absence of this project and the likelihood of an ambulance crew taking the patient to A&E according to the attending paramedic practitioner.
GPs and practitioners both report high satisfaction levels with the pilot, with the latter reporting high job satisfaction levels as well.
3. Pooling and benchmarking data
There is some evidence that benchmarking clinical outcomes data can drive up and standardise quality. The Practice employs a data analyst to extrapolate clinical activity data from all its practices, with monthly inter-surgery comparisons e.g. total consultation numbers granulated by demography or clinical condition, producible at a mouse click.
The Practice hopes this data will help deliver a more efficient approach to workforce and resource deployment decision making, driven by patient needs and targeting improved outcomes.
More broadly, delegates commented on the wealth of data sitting in GP IT systems that is a challenge to extract. Such data, packaged correctly, can inform GPs, commissioners and community providers about local health needs and disease patterns, revolutionising how health services are commissioned. But as one member pointed out, there is huge variation in coding behaviour among GPs and other health professionals; distilling data into something meaningful, let alone comparable, is currently a near impossible task.
With a future digital framework for general practice on the horizon, one area which may warrant discussing is ways to ration and homogenise current clinical coding practice.
Creating the right conditions
A recurring theme of discussion centred on the conditions that members felt they needed to implement digital innovation. Namely, members indicated that operating at scale can offer benefits in terms of technology implementation. For example, scale offers opportunities to pool resources, to employ professionals with appropriate skillsets and to free up time for exploring technological solutions to issues.
Barai K (2015) ‘How are GPs adopting digital innovation?’. Nuffield Trust comment, 27 August 2015. https://www.nuffieldtrust.org.uk/news-item/how-are-gps-adopting-digital-innovation