A few weeks ago we jointly hosted a webinar, prompted by our work with digital companies working in primary care, in which we set out to address how digital technology could alleviate the pressures on the front line in general practice which are currently attracting so much attention – staff burn-out and retention, patient access and experience, increasing demand. We were joined by colleagues from the Royal College of General Practitioners, the London Borough of Tower Hamlets and – reflecting Health Innovation East’s work – the Cambridgeshire and Peterborough ICS, as well as leaders from two technology companies supporting primary care. Inevitably the discussion ranged more widely than just the potential for digital technology in general practice.
When the issues in primary care and general practice appear to be so multi-factorial, it’s always a good idea to identify the key drivers of value and how they can be strengthened. One of our panellists stated eloquently that the value of general practice lay in “relationship-based medicine and continuity of care”. Many patients place a unique value on this, as do GPs, for the patient interaction that contributes so much to their job satisfaction. We agreed, therefore, that the future role of technology is less likely to consist in replacing the consultation (despite the increasing number of AI-driven clinical decision support tools and chatbots) as in automating the middle office and back office functions that support general practice.
But the difficulty in achieving widespread implementation of assistive technology lies in the scale of the transformation required. Many general practices still operate on the traditional small business model, with little or no funds available for transformation. This is anachronistic, given that general practice still carries out around 88% of patient-clinician contacts in the NHS. Despite the traditional funding mechanisms, we therefore see an urgent role for ICSs in providing direct financial support for technology-enabled transformation in general practice and primary care, perhaps through the primary care networks (PCNs). Inevitably, many of the larger practice groups will be further ahead than smaller practices in implementing technology support (e.g. for online triage and access, availability of test results, access to clinical trials). But scale does not necessarily result in better patient access and experience, and can create inequality where a patient’s local practice is not part of a larger group.
ICSs need to recognise the importance of local clinical leadership in driving change, given its role in creating the most successful practices. They should support partners and leaders in general practice to adopt the technologies most likely to result in increased access and quality of experience for their patients. ICSs could also consider how value-based procurement models could ensure that new technology purchases are based on the value they bring to the system and patients and not on crude metrics such as price and number of features. This seems to us to be a discrete area of work that aligns well to the recent Fuller report on primary care, with its vision of neighbourhood teams aligning their services around the different needs of a local population, and a more ambitious and joined-up approach to prevention.
Read the full readout of the webinar here.
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