The future of general practice can look bleak. Workforce shortages, growing financial pressures and demanding patient and policy expectations are exerting serious strain.
But these pressures are also starting to drive a fundamental transformation in what constitutes general practice – one which, if all goes well, might just create a more sustainable service.
Better use of technology is a key part of the transformation. This is reflected in the General Practice Forward View, which sets out considerable investment for general practice technology – including an 18 per cent increase in clinical commissioning group (CCG) funding.
We recently looked at six organisations that have changed how they work with the help of digital tools. We found primary care is evolving in ways that take it far from the traditional model of a doctor in a small, local surgery treating a sick patient. Three of these trends were: general practice at scale; digital triage to mixed teams of professionals; and greater patient self-care.
General practice at scale
The traditional model of lone GPs working in small local surgeries is dying out. The majority of GP practices are already part of a network or federation. For patients, this means they will not access services through their local GP, but instead through an online hub or call centre, where the case will be assigned to the least busy practice.
Access to shared clinical and administrative information means that no matter which practice the patient visits in the network, all professionals will see the same information.
The General Practice Forward View refers to much-needed national efforts to ensure different clinical software systems will be able to work together by 2020.
In the meantime, pioneering organisations are finding their own ways to share information. South Somerset Symphony is a primary and acute care system (PACS) using one shared record, as well as the Patients Know Best platform – which gives patients access to their clinical data. Preliminary results for the new model, based on a small number of patients, show a reduction in the number of admissions, in the number of A&E attendances and in length of stay.
Multi-disciplinary primary care team and more effective triage
We found that leading practices are already using online tools to manage demand and make the most of a multi-disciplinary workforce, which means a patient might find themselves sitting opposite a pharmacist, paramedic or physician associate rather than a GP.
West Wakefield Health and Wellbeing Limited has developed a care-navigation app, which provides a logical decision tree to help patients find the most appropriate care. It signposts patients to information and resources as well as physiotherapy, pharmacy and mental health services, before offering a GP appointment if appropriate. This is supported by a large service directory that draws on several databases and social media to let patients know about all services in the local area.
Further Nuffield Trust work on how the use of digital tools by patients is likely to impact on general practice is uncovering multiple opportunities to triage patients more effectively – whether through a central online system or individual practice websites, for example.
Promoting self-care and dual accountability
The importance of patients taking greater responsibility for their own health and wellbeing is emphasised in the General Practice Forward View, particularly in relation to the use of technology.
Our research found that giving patients access to their clinical data and medical history can have very positive results in terms of engagement and, ultimately, outcomes.
VitruCare is a software product which enables care planning, with an online portal and apps for patients. They use these to enter their readings into the system. The GP makes a decision about which data should appear in the clinical record and is alerted to any anomalies via a dashboard.
With the continued support of their GP, patients can make decisions using the data from their electronic health record to change their lifestyle and improve their overall health. For example, a patient planning to lose weight can enter data onto VitruCare, and then see whether they are succeeding against their aims. Or their Bluetooth-enabled bathroom scales can report the data automatically.
An evaluation of VitruCare with a small group of patients showed health care contacts declined by 53 per cent after patients adopted care planning. Total costs were also reduced from £97,534 to £42,752.
The future is bright, the future is difficult
Our research shows that general practice is transforming, and technology is playing a fundamental role. But change is not easy, and while some organisations are leading the way, others are finding it incredibly hard.
The pioneers we looked at had received ad hoc funding either through the Prime Minister’s Challenge Fund or the Vanguard programme. The financial investment needed is significant, and those without additional funds are at a real disadvantage. The funding announced in the General Practice Forward View may be a start.
Other challenges include privacy concerns which can inhibit effective data sharing, and which are not helped by a complex and confusing information governance landscape; a limited workforce pool to recruit multi-disciplinary teams; and the hard work that it takes to get genuine patient engagement.
A sustainable, efficient, co-ordinated service underpinned by digital solutions and engaged patients may seem far away for GPs struggling to cope. But the General Practice Forward View and the flashes of success we have seen in pioneering organisations make it easier to see how we will reach it. It is time to start thinking about how everyone can get there.
A version of this blog first appeared in the HSJ.
Castle-Clarke (2016) ‘The emerging new era of general practice’. Nuffield Trust comment, 10 May 2016. https://www.nuffieldtrust.org.uk/news-item/the-emerging-new-era-of-general-practice