Deloitte - Primary care is failing to embrace digital health at scale

Profile picture for user ddpreez By Derek du Preez November 10, 2016
A new report released by Deloitte this month highlights the opportunities for primary care in the UK if it figures out how to adopt digital technologies.

healthcare technology
A report released this month by Deloitte highlights the significant pressures facing NHS primary care providers in the UK. A big part of the solution, of course, is the adoption of digital technologies - to not only alter the shape of the primary care workforce, but also to help patients manage their health.

However, the report also highlights that these technologies are not being adopted at the scale required to make any sort of significant impact.

The report adds that since 2012, escalating austerity pressures have led to a relative lack of investment in primary care (despite the government noting that effective GPs take pressure off of hospitals), and that the average number of consultations per person has increased from 10 to 15 percent in the past five years.

To make matters worse, the increase in demand is not being matched by an increase in the supply of skilled professionals. In fact, the number of GPs, community and district nurses per population have steadily declined. The ratio of GPs to the population has reduced 0.67 per 1,0000 in 2010 to 0.62 per 1,0000 in 2015.

In other words, there are significant pressures on the system, a lack of resources and dwindling skills base. However, as Deloitte notes:

Despite reform efforts over the last four years, the key enablers that might support primary care staff to work differently, including the adoption of technology, have not yet been adopted at scale.

Better management

Deloitte’s report is broad ranging, but there are some useful strategies that have been highlighted for consideration. For example, it looks at how primary care units, general practices, could take advantage of readily available technologies to better manage demand for services.

For instance, GPs have taken to the use of telephone triaging (a very basic tool) since 2012, where they have generally found that one third of demand can be handled over the phone, reducing A&E attendance by up to 20 percent. But a lot more can be done.

The report states:

Patient demand for help from the healthcare system is highly predictable, and a GP surgery can effectively plan to meet it and offer same-day access for patients. Organising the resources of the practice and GP time can be oriented to meet these predictions as precisely and appropriately as possible.

One example it provides is the solution askmyGP, which has been piloted by four practices in Northern Ireland since May 2016. It allows patients to email their GP at their own convenience, enter their details and symptoms online and answer a set of structured questions with one-click answers, creating a medical history. They also see information relating to their systems, which some decide is all the help they need.

Evidence shows that two thirds of patients can be dealt with remotely, yet clinical quality is improved as many more questions can be asked by the askmyGP system than most GPs have time for. Given the evidence of the four pilot sites (including a reduction of face-to-face consultations by up to 50 per cent) the Northern Ireland health board has requested a larger scale rollout with 10% of the population to be covered by the end of 2016.

In addition, according to the report, home-based and self management of long term chronic conditions has proven to be useful in reducing stress on services, where it has been adopted in parts of the country. Health Call, for instance, is a partnership between County Durham and Darlington NHS Foundation Trust and Inhealthcare Limited, which aims to enable patients and healthcare professionals to manage International Normalised Ratio (INR) monitoring, nutrition, chronic pain an obesity at home.

The benefits have been significant. Deloitte states:

For example, patients on warfarin require regular blood tests which traditionally requires time consuming clinic attendance. Health Call means they can self-monitor, submitting home-readings through an automated phone call or an on-line portal. The data and the current dosage of warfarin to be used is calculated by specialist nurses in the clinic and the patient then receives a second automated phone call to inform them about their next dose of warfarin and when their next INR test required – always at a time to suit the patient.

Evidence shows that self-testing INR at home is found to be 17 per cent cheaper than in clinics and 25 per cent cheaper than home visits. Patient satisfaction is high and clinical outcomes improved. In addition, a study involving 100 patients at risk or suffering from malnutrition showed cost savings of £21,550, resulting from the impact on clinic appointments, dietician visits and optimisation of prescription of nutritional supplements.

Improving GP premises

Deloitte believes that the need to improve general practice premises, via the use of technology, is the second most important factor, after better management of the workforce, in securing a sustainable future for primary care. However, it notes that the NHS England Estates and Technology Transformation fund is unlikely to meet the the full extent of modernisations needed and that other ways of funding improvements will be required.

Some of the technology suggestions it outlines, include:

• interoperable, integrated electronic health records (EHRs) that patients can access and interact with, which are shared with all staff who come into contact with the patient (but with patients having control over the information different people can access)

• improved diagnostic capability, including point-of-care diagnostic testing (for example digital blood testing, atrial fibrillation, and tests for bacterial or viral infections) and if appropriate direct referral to imaging, such as MRI and CT scans

• technology-enabled communication systems that enable patients to email staff, access online appointment booking and obtain e-prescriptions

• deployment of telehealth and telecare to monitor and support people in their own homes
• prescribing approved (‘kite-marked’) digital devices and health apps as an alternative to, or supplementary to, drug prescriptions, alongside technology to monitor compliance and adherence.

My take

The NHS is facing real challenges at the moment in terms of increased demand, reduced funding and structural reform. However, primary care is the key to taking pressure off other areas of the system. Getting the use of technology right could really help - if only the government and NHS England could recognise that investment needs to take place now, in order for savings to me made further down the line. For anyone that has tried to book an appointment with their GP online or carry out an e-consultation with their doctor will know that the service is generally pretty poor. If we want to maintain free healthcare at the point of delivery, we need to get this right.