General practice is changing, whether we like it or not.
The fact that GPs are struggling like never before will be news to nobody. With less money, practices struggling to get the staff they need, and patients needing more and more complex care, the primary care sector has to adapt – and quickly.
Already, GPs are scaling up, joining forces across practices and collaborating with secondary, community and social care to try to address some of these challenges. Organisations are also trying to be more proactive in their care and target services toward those with the greatest need. Meanwhile, national policy has driven an emphasis toward improved access to services, forcing practices to come up with new ways of communicating with their patients.
Amid all the upheaval of transformation plans, new models and policy initiatives, it’s easy for change to feel overwhelming; the end result a distant unknown. But as our new briefing explores, technology – an often underused resource in health care – could be a powerful force in shaping what this metamorphosis will actually look like, and importantly, how we might get there.
Shared electronic health records
If GPs and their colleagues are going to work across teams, disciplines and even locations, it makes sense for them to be sharing their data. Shared records can smooth out joint care arrangements, hospital discharges and patient handovers. Given access to records, professionals have all the information they need to make the right decisions and make interactions more convenient for patients.
For mobile community teams, shared records can completely transform the way they work, eliminating the need to return to physical headquarters every time they need to print and update patient information.
Collecting and storing data from a range of sources (including consumer and remote monitoring devices) enables practitioners to proactively find those patients at most risk. GPs can screen populations and intervene early, which may go some way towards slowing the rise of long-term conditions.
Improving communication will enable GPs and other professionals to make decisions together, wherever they are. Real-time phone, video or web consultations allow GPs to seek specialist opinion during or shortly after consultation – so a patient can benefit from expert consultation without disrupting their relationship with their GP.
Patient-to-professional telehealth can really improve patient access. Real-time consultation technologies such as phone or video may mean GPs can see more patients quickly, since remote consultations are often shorter than face-to-face visits.
Remote access to clinical systems and telehealth enable staff across sites to share workloads and cover for staff sickness, which could decrease demand for advanced appointment bookings and extended hours.
Patient portals give patients access to their records, including test results; information and advice for self-management/self-triage to other services; and opportunities to book GP appointments or order repeat prescriptions online. These technologies can improve efficiency within practices, allowing administrative staff to be deployed elsewhere.
It’s possible that data and resources could also help patients to self-manage their health and wellbeing, particularly those with long-term conditions, although the evidence is mixed about whether this can actually reduce demand on GP time.
But realising these benefits won’t be easy
So, technology can really support new models of primary care. But there are still obstacles to realising these benefits.
Despite ongoing work, many clinical systems are still not compatible with one another, which makes sharing records challenging. And the analysis of patient data and predictive analytics to allow GPs to intervene early require appropriate data processing tools and resources, including data analysts.
If professional-to-professional telehealth is to take off on a large scale, investment in infrastructure is needed, as well as buy-in from all parties. If staff don’t make time to offer remote support, it’s unlikely to work in the long term.
This is also as much of a culture change as it is a technological one, and attitudes toward technology can be barriers in themselves. While patient-to-professional telehealth can improve access, some research suggests that reducing barriers between patients and health care professionals can actually increase demand. In the absence of clear evidence, many doctors fear that tech-enabled consulting will increase their workload or create risks that do not exist with face-to-face consultations. As a result, GPs can be very resistant to using remote technology.
There may also be reluctance from patients. Some practices have reported difficulties in encouraging patients to book appointments and order prescriptions online.
And, inescapably, all of this requires money. The primary care organisations that have made the biggest strides in introducing technology have benefitted from funding sources such as the Prime Minister’s Challenge Fund – but these resources are finite.
So how do we get there?
Much of the hard work needs to be addressed at a local or organisational level. Patients, clinicians and CCGs all need to be on board, and leaders must have the time and resources to make changes.
But there are also things that national bodies can do to help practices on their journey. They should foster an environment that supports local freedom to innovate and adopt technological solutions. Rigorous data standards would ensure that there was a central direction, but there must also be support for local flexibility and autonomy. Critically, they must ensure that primary care organisations have stable sources of funding – either through contracts, incentive mechanisms, digital funding streams or a mixture of all three.
The tools and technologies that could benefit the sector, its staff and its patients are already out there. But this digital revolution will require all sides to come together and make room for new ways of working.
General practice is already going through a painful transformation. Used in the right way, technology can help to ease the pain.
Castle-Clarke S and Kumpunen S (2016) ‘The Health and Social Care Bill gets a second opinion’. Nuffield Trust comment, 7 April 2016. https://www.nuffieldtrust.org.uk/news-item/technology-in-general-practice-a-vehicle-for-change