Earlier today, the heads of NHSX and NHS Digital, discussed ‘digital transformation in the National Health Service’ in front of a parliamentary committee in Westminster.
NHSX is a government unit set up last year to focus on NHS technology, digital and data (the ‘X’ stands for ‘user experience’). NHS Digital provides IT infrastructure and support.
After 35 minutes focused on the emergency response to coronavirus, the session moved on to examine ongoing obstacles and opportunities for technology in healthcare (‘healthtech’) more broadly – the extent to which fax machines are still being used received an unexpected mention, along with issues such as IT bandwidth and ‘remote’ patient monitoring.
The select committee’s focus very much captured the moment: Covid-19 is clearly the national priority and has placed the NHS under enormous strain. But, in parallel, the pandemic has created – almost overnight – a surge in GPs’ use of digital tools, catapulting the challenges and possibilities of ‘healthtech’ to greater prominence.
‘Technological revolution’ in general practice
With coronavirus limiting face-to-face contact, general practice has undergone a ‘technological revolution’ during the pandemic, the Royal College of General Practitioners (RCGP) says.
It has undertaken research of 829 GPs across the UK, which found that between 9 and 22 July, 61 per cent of GP appointments were conducted by phone, with a further 16 per cent spent doing telephone triage. Eleven per cent were conducted face to face, six per cent by SMS or email, four per cent online via video and three per cent were home- and care-home visits.
While just four per cent of consultations were reported as being done by video, the survey found that 88 per cent of respondents said their surgery was equipped to deliver video or e-consultations – up from five per cent before the pandemic – and that 74 per cent said they had done at least some consultations in this way.
‘Integration’ among the challenges
Graham Kendall, is director of the Digital Healthcare Council, a membership organisation launched two years ago with 15 healthtech companies, including Babylon Health and Swedish firm Livi, as members.
Kendall sees the growth in ‘virtual’ consultations as “just the start” of digital healthcare’s possibilities.
“Face-to-face consultations remain important and, clearly, there’s a limit to how doctors can examine patients, and administer solutions, remotely,” he says, emphasising that safety is paramount.
In his view, one of the big advantages – to all – of virtual GPs is the actual or potential efficiency gains: enabling doctors and patients to be more quickly matched given their specialty or ailment. “A lot of the technology already exists – the challenge is integrating video consultations into patient journeys through the health system,” he tells City AM.
When coronavirus hopefully subsides, Kendall would like to see virtual GP services used to help clear the growing backlog of patients with non-urgent illnesses, as well as – in the longer term – helping with the pressures of demographic changes, such as people living longer. “These fundamental pressures and an increasing patient appetite for accessible, always-on care, will drive innovation in digital healthcare and encourage widespread adoption over the foreseeable future,” he says.
‘Digital healthcare is here to stay’
One of the growing number of companies active in digital healthcare is Doctor Care Anywhere (DCA), which was set up 2013.
Its founder and chief executive is Dr Bayju Thakar, a former NHS doctor who also previously worked in consulting at McKinsey. He says that DCA has about 200 doctors on the books – some full-time and some who work also in the NHS – as well as employing about 150 non-clinicians in roles such as software development.
He sees numerous trends as driving growth in the market for ‘virtual GPs’: rising patient expectations, accelerated by coronavirus, that doctors be more available at non-standard hours, including by video-call; and what he sees as a growing number of doctors who are keen to embrace technology and work flexibly (for example, working two days per week for the NHS and then evenings or other days working for firms such as DCA).
“Digital healthcare is here to stay. The pandemic has proved the need for it and popularised it with clinicians and patients alike. Remote GP consultations are just the start,” Thakar tells City AM. Businesses such as DCA are, he says “joining up the dots between primary and secondary care, and beyond, achieving better outcomes for patients, and greater levels of efficiency, transparency and accountability in the delivery of care.”
‘You can build a rapport’
Dr Isabel McQueen is an NHS GP on Tyneside who is generally positive about the more digital ways of working that she and her colleagues have taken up since March.
“’Video surgeries’ can be very helpful if we want to see patients and interact with them, for example with patients with learning-disabilities, children and those in care-homes,” she tells City AM. “Video consultations can also be used for mental health in a more effective way than ‘e-consultations’ as you can build a rapport.”
This week McQueen undertook a virtual ‘ward round’ in a care-home, interacting with patients. “They appeared delighted to see a familiar face, and be able to ask their questions directly, while keeping them safe from unnecessary contact,” she says.
50-50 remote/face-to-face split ‘realistic’
A fortnight before the national lockdown, the chief executive of healthtech service Doctorlink, Rupert Spiegelberg, wrote in City AM that ‘Covid-19 could well go down in history as the moment of profound change’ in the use of technology and that ‘even sceptics are being forced to acknowledge the benefits of video conferencing’.
Fast-forward to today, and Doctorlink reports 292% growth in the use of its video consultation tool from March to July (compared to previous equivalent number of months).
“Beyond Covid, I can see video consulting being a valuable way to complement face-to-face consultations, which will still be needed and important for many patients,” reflects McQueen. “GPs can see more patients ‘virtually’ rather than visiting – although this will still be needed where examination is required – and is convenient for patients who cannot travel in due to work or transport issues”. The RCGP’s chair, Prof Martin Marshall, meanwhile says: “It is in no one’s interest for general practice to become a largely remote service, as that will run the risk of isolating some patients, for example those with complex needs as well as our less tech-savvy patients and those who don’t have access to the appropriate tech – this, in turn, risks exacerbating health inequalities.”
He continues: “The way in which GPs switched to a largely remote service has been remarkable, and it has played an important part in helping to slow the spread of Covid-19. But moving forward, we envisage more of a balance in the way people access GP services, perhaps with 50 per cent face-to-face and 50 per cent remote appointments. This seems realistic and sensible.”