GP practices are under more pressure than ever. Their workload has grown as they have seen a 13% increase in appointments over the past five years – around three times the rate of increase in the number of GPs.
Dominic Arkwright is the co-founder of The Sound Doctor, whose films on self-management of long-term conditions have had helped reduce the need for face-to-face contact. Here he discusses how the provision of high-quality information help patients manage their own health conditions, as well as what practices can do to support this process
Practices are finding it hard to recruit and retain GPs. The same is true for practice nurses and practice managers. Any wonder? The work is becoming more complex and more intense, mainly because the population is ageing, more people are living with complex or multiple conditions and patients’ expectations are rising.
So, the workload has increased substantially but this hasn’t been matched by a growth in either funding or staffing. One solution is to encourage the development of the primary care workforce; another is to accelerate the uptake of technologies that can help practices deal with growing pressures.
There’s been a substantial rise in the number of telephone consultations, or triage, – up 63% since 2010/11 (King’s Fund 2016) – but this might, surprisingly, actually increase demand. In fact, research shows that telephone triage is associated with an increase in contacts, although not in costs (Campbell et al 2014).
Effective self-management programmes can reduce both contacts and costs.
Once upon a time, before families fragmented and the extended network dissipated, people learned how to look after themselves and their families. Now the first port of call is the GP.
There’s been a lot of work done to help people engage with their health and to support them manage long-term conditions, in particular. Some programmes require physical attendance – for example, DESMOND and DAFNE for type 2 and type 1 diabetes. But, in 2018 – when almost everyone has a smartphone – virtual, digital education seems an essential part of self-management. Certainly, people who understand their condition are more likely to have better health outcomes, make better lifestyle choices and take their medicines as prescribed.
There have always been leaflets but that’s not sustainable in the YouTube age where people expect their information to come via video; it’s more accessible, more engaging, more fun and, probably, more effective. In our case, the material is usually distributed through GP practices at the appropriate point in a care pathway and has the benefit of feeling like it’s a prescription, rather than a modern-day leaflet.
Our own research at The Sound Doctor found that more than 90% of people who’d viewed our video material said they visited their GP less often. And nearly two thirds reported fewer hospital admissions. Dr Darren Jackson, a GP with responsibility for overseeing long-term conditions in Leicestershire said, “The Sound Doctor is a very popular resource for us and for our patients and provides an effective way of getting information to large numbers of people at low cost.”
Access to health information
Increasingly people are using their tablets and smartphones to access health information. A short film about how to deal with a chronic obstructive pulmonary disease exacerbation, how to interpret blood glucose test results, or how to use your new inhaler, can save patients the trouble of a visit to the doctor and give the GP more time for patients who really do need to see her, or to catch up with paperwork – or play golf!
The digital health market
There are many young companies in the UK developing apps that will provide virtual consultations, online prescriptions and other services. Whether they’ll satisfy what seems to be a deep-rooted cultural desire to see our very own actual doctor in the flesh is debatable and, certainly, many seem to find it hard to push open the heavy NHS procurement doors.
But one thing’s for sure. If people aren’t given the option to learn and understand their own health in the way they wish to, the pressure on GPs will go on increasing and morale will continue to decline – and, if the pressure on GPs increases, even fewer GP trainees will want to go into general practice full-time. Why is the NHS so reluctant to invest in new learning technologies?