The COVID-19 pandemic has accelerated the mass adoption of digital tools and solutions to ensure care is continued in challenging situations. Now, the NHS must collectively utilise these lessons in order to continue maximising the benefits of automated tools and manage the backlog of care that has amassed.
Healthcare, and particularly primary care, is now expected to be delivered in a more innovative, proactive and systematic way. However, this partially relies on the capability for data to move beyond conventional limits. It also rests on the ability to link the different elements of primary and community care, including pharmacy, GP practices and out-of-hospital care – to facilitate improved shared and preventative care.
With all this in mind, Gianpiero Celino, clinical director, Cegedim Healthcare Solutions, looks to the future of digital healthcare, building on the significant progress the NHS made last year.
Given the speed of technological evolution over the past decade, it is unfortunate that the digital technologies used across primary care still fall behind in the way clinicians want to deliver patient services. So what must change and what can be achieved?
An extraordinary level of collaboration had already been attained between GP practices and an entire network of health care providers before the pandemic hit – and the reaction from the NHS to the virus emphasised the value of that co-operative model. From the nurses and pharmacists that play a critical role within practices, to the hospital consultants and care homes, the idea of working together as a team to carry out patient care is now firmly accepted.
But, technology must adapt to support that clinical imperative. Collaboration at practice level is already supported by GP clinical systems that share patient information across teams within a practice. However, at the moment, there is no satisfactory, wide-scale adoption of systems that allow true shared care to happen across multiple GP practices, community care services and local authorities. This is the crucial problem that needs to be addressed as a priority this year.
Collaboration is key
The NHS response to the COVID-19 pandemic increased far more than the use of new digital technologies. Indeed, the adoption of triage solutions and video consultations was fast-tracked, meeting both a pressing need to offer non-face-to-face patient care, and providing a foundation for the transformation of the way patients and clinicians communicate. But, even more importantly for the future of primary care services, the response demonstrated what can be accomplished with the right perspective, dedication and collaborative approach.
Hurdles were overcome, bureaucracy thrown aside and the previous obstructions around NHS IT expansion disappeared. NHSX’s prompt issuing of guidance on data and privacy protection, for example, was a key intervention that saved considerable amounts of time, as well as advanced the deployment of new technologies.
The solutions deployed in response to the crisis are not flawless - however, they have provided a specific view of what digital technologies can and must enable within primary care – and now is the chance to ‘build back better’ throughout the NHS.
The COVID-19 mass vaccination programme has highlighted both the need for, and challenges associated with data sharing across a wider health economy, as it demands multi-disciplinary cooperation. Safely vaccinating as many as one thousand patients at a time bears no relation to the number of flu vaccinations undertaken daily within a GP practice, and will require the joint effort of various service providers.
This reiterates what is required to achieve successful teamwork across the wider health economy. The technology needs to assist individuals working in separate locations, while still using familiar systems and working methods to reduce interference. It needs to ensure each health care provider has immediate access to helpful patient information irrespective of their whereabouts– from GP surgeries, to clinics or patient homes. Critically, at the heart of this collaborative model must remain the concept of the GP record as the single version of patient truth.
This approach works for both patients and clinicians. It reinforces community care providers and enables a seamless link between primary and secondary care.
Having a collaborative approach creates a unit of healthcare providers acting as one, sharing, coordinating and collaborating to deliver the best possible care. This shifts the model from one based on intermittent, appointment led patient interaction, to one where the multi-disciplinary team can offer a programme of ceaseless patient review.
The management of type two diabetes is a key example of a difficult condition that requires a multi-disciplinary team involving doctors, pharmacists, specialist diabetes nurses and health educators. These patients need persistent review – but there are also notable benefits associated with continuous support that does not require a specific appointment.
On top of the standard annual review, productive data sharing between health care providers and the patient enables the entire team to collaborate on a daily basis. Frequent updates about how the patient’s diabetes is being controlled means health care professionals can welcome proactive care by recommending changes to diet, lifestyle or medication at any time.
The current and future course for primary care must have a multi-disciplinary way of providing patient care. The priority for 2021 is to identify and focus on the technology gaps shown by the COVID-19 NHS response, and to use that insight to attain extensive adoption of an effective community care model. This means specifically addressing what must be delivered – and ensuring the barriers that have been broken down do not happen again.
Clinician expectations surged during the pandemic – and there is no appetite for a return to the tortuous national strategic developments that take years to realise. GP practices want IT suppliers and systems that will adapt to support service delivery throughout a wider health economy. They are expecting innovation and accelerated delivery of new solutions that work promptly in these new settings. They want not just GP systems, but digital technologies that allow collaboration at scale to look after patients throughout the wider health economy. Yet, this can only be achieved with the commitment of all stakeholders within each local health economy.
COVID-19 has been a catalyst for fundamental change. The response proved what can be achieved with the correct commitment and outlook. However, it must be at the right scale - which is not necessarily about defining a national strategy; it is about getting the right local stakeholders within a local health economy to work together. It is the cooperation of policy makers, front line clinicians and IT suppliers within a local area that will advance developments and fulfil the future of collaborative, shared primary care services to deliver effective patient care.