Building on the huge progress the NHS made during 2020, Gianpiero Celino, Clinical Director, Cegedim Healthcare Solutions, outlines a vision for the future of digital healthcare.
The Covid-19 pandemic witnessed the mass adoption of digital tools and solutions to ensure continuity of care in challenging times. Healthcare, particularly primary care, is now expected to be delivered in a more effective, innovative, and responsive way – and this depends in part on the ability for data to flow past traditional boundaries. It also rests on the capacity to connect the different elements of primary and community care – GP practices; pharmacy; and out-of-hospital care – to facilitate better shared and proactive/preventative care.
With the speed of technological evolution over the past decade, it is unfortunate that the digital technologies utilised in primary care largely still fall behind the way clinicians want to deliver patient services. So, what must change and what can be achieved in the future?
GP practices and health care providers had already achieved an extraordinary level of collaboration well before the pandemic hit – and the way the NHS had to respond to the virus highlighted the value of that cooperative model. From the pharmacists and nurse practitioners that play a vital role within practices, to the hospital consultants, opticians, dentists and care homes, the concept of working together as a team to look after patients is now firmly established.
Technology must evolve to support that clinical imperative. Some advancements had been made pre-COVID. Collaboration at practice level is already supported well by GP clinical systems that share patient information across teams within a practice. Although, there is still no adequate wide-scale adoption of systems that provide for true shared care to happen across multiple GP practices, local authorities and community care services. For 2021, this is the immediate issue that needs to be addressed as a priority, as well as in the future.
‘Build back better’
It is true that the NHS reaction to the COVID-19 pandemic sped up a lot more than the use of novel digital technologies. Yes, the adoption of triage solutions, telephone and video consultations was accelerated. This met both an immediate need to provide non face-to-face patient care – and will provide a basis for the transformation of the way patients and clinicians interrelate. But, more significantly for the future of primary care services, the response demonstrated what can be achieved with the right commitment, attitude, and collaborative approach.
Hurdles were conquered, bureaucracy thrown aside and the previous obstructions that typically hinder NHS IT development evaporated. NHSX’s instant issuing of guidance on privacy and data protection, for example, was a critical intervention that saved vast amounts of time and facilitated the deployment of advanced technologies.
Albeit, no one is advocating that the solutions implemented in reaction to the pandemic are faultless. They have, however, provided an enticing vision of what digital technologies can and must enable within primary care – and throughout the NHS, now is the chance to ‘build back better’.
The collaborative approach
The collaborative approach creates a team of healthcare providers acting as a whole, sharing and cooperating to provide the right care at the right time to the benefit of all patients. And it changes the model away from one based on sporadic, appointment led patient interaction to one where the multi-disciplinary team can undertake a programme of ongoing patient assessment.
A prime example of this is the management of type II diabetes, a complex condition that needs a multi-disciplinary team involving doctors, pharmacists, health educators, consultants and diabetes nurses. These patients require regular review – but with continuous support that does not require a specific appointment, there are notable advantages.
On top of the typical annual review, efficient data sharing between both healthcare providers and the patient allows the full team to work together throughout the year. Constant updates about how the patient’s diabetes is being managed means team members can adopt proactive care by recommending changes to diet, lifestyle or medication whenever is appropriate.
Of course, the demand for, and challenges connected with data sharing across a wider health economy have been accentuated by the COVID-19 mass vaccination programme which requires multi-disciplinary collaboration across a wide health economy. Securely vaccinating as many as one thousand patients at a time bears no relation to the ten or so flu vaccinations handled daily within a GP practice and calls for the cooperation of numerous service providers.
This highlights what is essential to reach a truly effective team working across the wider health economy. The technology needs to assist individuals working in different locations, while still using familiar systems and working methods to lessen any disruption. It needs to ensure individual health care providers have immediate access to critical additional patient information wherever they are – from GP surgery to dedicated clinics and patient homes. And, vitally, the idea of the GP record as the single version of patient truth must remain at the centre of this collaborative model.
This method works effectively for both patients and clinicians by providing a seamless link between primary and secondary care and also supporting community care providers.
The current and future direction of travel for primary care is this multi-disciplinary way of delivering patient care. The priority for 2021 is to address the technology gaps highlighted by the COVID-19 NHS response and to apply that knowledge to reach a wider adoption of a broad, effective community care model. And that means concentrating very specifically on what must be delivered – and making sure the barriers that have been broken down are not re-erected.
With clinician expectations raised during the pandemic, there is no desire for a return to the tortuous national strategic developments that take years to realise. GP practices want IT suppliers and systems that will develop and flex to support service delivery throughout a wider health economy. They are anticipating innovation and rapid delivery of new solutions that work instantly in these new settings. They want not just GP systems, but digital technologies that provide for collaboration at scale to wholly look after patients.
This can only be realised with the commitment of all the stakeholders within each local health economy. COVID-19 has been a catalyst for extraordinary change: the reaction proved what could be achieved with the right mentality and dedication. But it must be at the correct scale. This is not necessarily about determining a national strategy; it is about getting the right local stakeholders within a local health economy to collaborate. When policymakers, front line clinicians and IT suppliers work together within a local area it will facilitate change for the future based on clinical imperative and help realise the delivery of the next generation of collaborative, shared primary care services, as we move forward.