One year on from the first confirmed case of COVID-19 in the UK, Oli Hudson, Content Director at Wilmington Healthcare, takes a look at some of the key changes that have happened during the pandemic, how NHS pathways are evolving and what this means for pharma.
The COVID-19 pandemic has created an urgent need to change patient pathways, particularly with regard to keeping patients out of hospital, where possible, and providing more care in the community and at home.
As a result, we have seen the development and rapid roll-out of a number of new pathways across a range of therapy areas – changes that are likely to remain post-pandemic, given their synergy with key NHS Long Term Plan goals.
In this article, we will explore some examples of where this has been happening across the NHS for different conditions; the thinking behind them and how they are likely to impact on pharma’s value propositions for the NHS.
Ophthalmology is an area where, Getting It Right First Time (GIRFT) – the nationwide programme that seeks to deliver improvements in practice, staffing, procurement and technique in a variety of clinical areas – has been particularly active.
Since the pandemic began, GIRFT teams have tentatively restarted deep-dive work on best practice, gathering data to provide evidence on how to best unlock the NHS’s capacity to be ‘high-flow’, and free up staff time to get millions of patients treated.
Cataract surgery is a good example of what this will involve, and it also indicates how other specialties could cope, given that pre-COVID-19 it was the most common operation. In particular, it is interesting to note that GIRFT recommendations favour the whole system approach and are very much in line with the Long Term Plan.
Recommendations include optimising hospital theatre time for routine cataract surgery to enable more patients to be treated faster and offering more care for age-related macular degeneration (AMD) in settings outside of hospital and closer to patients’ homes, such as mobile units and community eye clinics.
Patients with respiratory diseases have been at particular risk during the pandemic, hence the ability to manage them outside of hospital settings has been of growing importance. In line with this, an integrated respiratory service in Hillingdon, that was established before the pandemic to enable more patients to be treated in primary care, has been widely rolled out in the past year.
The joined-up adult respiratory pathway aims to achieve a number of ambitions, including a timely and accurate diagnosis of COPD and asthma patients. It is also designed to reduce the number of unplanned admissions for respiratory disease, particularly short-stay admissions and help patients to self-manage their care.
In its diabetes national report published towards the end of last year, GIRFT outlined a series of recommendations to improve care and services for patients. These include the suggestion that all NHS trusts should have a dedicated multidisciplinary footcare team as stated in the Long Term Plan.
This change would enable people with diabetes to access high quality footcare services wherever they live, so early opportunities to identify and treat foot problems are not lost. This locally delivered, preventative ethos, is closely aligned with key Long Term Plan ambitions.
Technology is, of course, a key enabler of pathway changes and its potential has been increasingly realised during the pandemic. In dermatology, for example, a new app is being used on the Isle of Wight that photographs and helps to diagnose skin conditions, including skin cancer. It rapidly shares images of suspect skin lesions between GPs and dermatologists. The technology reduces waiting times and follow-up appointments and supports social distancing.
Elsewhere across the NHS clinical teams have been utilising technology to redesign care pathways, with examples including the remote monitoring of patients with heart failure and hypertension, and the use of digital tools to facilitate periodic reviews of patients with long-term conditions. A series of digital playbooks that showcase this kind of work in the areas of cardiology, musculoskeletal (MSK), respiratory, eye care and dermatology can be viewed on the NHSX website. For more details, visit https://www.nhsx.nhs.uk/key-tools-and-info/digital-playbooks
Role for pharma
As we can clearly see, these new pathways have a number of common themes. However, the way they operate will vary between different therapy areas and geographical territories, hence pharma needs to track them individually.
Industry should also consider how a pathway has changed for all parties involved – patients, practitioners and partnerships – and the effect on healthcare settings, sponsoring clinicians and healthcare providers.
Understanding how products fit into whole pathways and determining how they might alleviate pressure elsewhere in the system by, for example, delivering better outcomes that prevent readmission to hospital, is key.
There may also be opportunities to support hard pressed GPs and practice nurses who may have had a new influx of cases to manage as more care gets moved into the community.
Finally, to capitalise on innovations and continue to drive improvements, the NHS needs to monitor how new patient pathways are performing and how COVID-19 is impacting on its services regionally as it aims to Reset services.
Data is key and there is an important role for pharma to play in gathering and analysing a wealth of pathway related information. This, in turn, may help to open up opportunities to work in partnership with NHS customers to devise preventative, population-based solutions to deliver care in these unprecedented times.
Oli Hudson is Content Director at Wilmington Healthcare. For information on Wilmington Healthcare, visit www.wilmingtonhealthcare.com