The new health secretary has signalled his intention to use technology to transform care in both hospitals and the community. In general practice, the spotlight has been on digitally enabled consultations and using online systems to book appointments, obtain test results and request repeat prescriptions.
My previous blog this week described various technologies already in use in some practices, and my colleagues at the Nuffield Trust have produced a comprehensive guide to technology in primary care. They describe various roles for technology in monitoring disease markers, risk factors and other biometric indicators, online triage, access to health information and advice, remote consultations and apps, and other sources of support for staying well and managing illness.
In combination, existing technologies could contribute to new forms of general practice that improve convenience for patients, ease workload and increase efficiency for doctors, support people to self-care, and coordinate services for people with complex needs. But a recent BMJ podcast described GPs as primed for a fight over technology, which is a woeful starting point.
Starting on the wrong foot
Why is it that so many GPs are hostile about technologies that should make their lives, and the lives of their patients, so much easier? There are several possible answers, including:
- Poor past experience of using IT programmes, which may have required duplicate data entry or additional work.
- Insufficient end-user engagement in developing software so it doesn’t do what clinicians want it to do, or raises safety concerns or is hard to use.
- Frustration at the inequalities associated with targeting scarce general practice resources into digital providers serving a typically younger, healthier group of ‘worried well’ patients. This leaves fewer resources for patients with complex problems.
IT implementation expert Professor Bob Wachter has summarised the challenges faced by clinicians, in terms of disruption and loss of productivity, before they can ‘reimagine’ their working lives supported by the technology.
Four ways to make it work
So I propose four must-do's to support the implementation of digitally enabled general practice, so that its benefits outweigh any potential risks.
First: avoid repeating the failures of the NHS’s last, top-down technology rollout – the National Programme for IT. Immediately engage a wide range of clinical end-users to co-design the role of digital technology in general practice. Not just the enthusiasts who are comfortable with the digital world and understand its potential, but also a more typical group who use different technologies regularly, but haven’t had time to think about how it can benefit them in their day-to-day practice. They will need time and resources to develop effective roles for technology within their own practices, and to connect their practices to the wider health system.
Second: change the nature of the debate from one that is dominated by consumerism and patient convenience to one that sees the world from both patient and professional perspectives. GPs are already overwhelmed by demand. We need to be clearer about the ways technology can confer benefits on both patients and professionals, and provide implementation support so that clinicians feel the benefits for their own working lives at the earliest opportunity.
Third, start discussions about how to develop the GP training curriculum to champion the use of digital technologies for the next generation of practitioners. I recently did a presentation to a group of GPs in training and was shocked by how few recommended patients to use apps. Many trainers are not yet comfortable with recommending technologies to support self-care, and the infrastructure needed to enable widespread use of apps and other digital technologies is still limited. So action is needed on several fronts to ensure that GPs in training are future technology champions.
Finally, bring in a mechanism to support implementation that recognises the period of lower productivity that GPs will experience when using new technologies. This may include permission to close practices or reduce the number of appointments offered for a short period of time, and will manage the pressure that technology implementation places on an already stressed workforce.
There is little doubt that technology could bring many benefits to general practice, but we need to implement it in a way that makes sure that it does.
Rosen R (2018) "Technology in general practice needs careful implementation", Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/technology-in-general-practice-needs-careful-implementation