The NHS is getting serious about technology. There are a number of tech Initiatives already underway – and more about to hit. What do GP practices really need, and how ready are they to embrace tech, and all the benefits it can bring? What’s getting in their way? We decided to find out.
In conjunction with our partner, business technology solutions’ provider Brother UK, Practice Business consulted practice managers, and other healthcare providers, to identify what the real barriers to change in general practice are because, if the sector can understand these, it can find solutions to overcome them. In this, the second in a series of six reports, we look at the general practice tech landscape and how we got here
General practice is faced with a very real challenge: delivering healthcare to a growing – and ageing – population with more complex needs and higher expectations, coupled with a finite pool of resources. The weight of this challenge is being felt right across the NHS; those working in the sector consistently report their fears that workload pressures are becoming unmanageable and administrative tasks are taking over. This is impacting workforce wellbeing and recruitment, as well as the delivery of care.
NHS service providers are increasingly looking to technology to support new models and, at GP practice level, technology is gaining traction as a possible way to streamline the delivery of healthcare. This is backed and promoted by government – as illustrated by recent investment, and health secretary Matt Hancock’s own ‘tech-vision’ for the NHS, which he outlined in autumn 2018.
The health secretary’s plans build on existing ones, such as Paperless 2020; they seek to improve digital-agility and support the deployment of the technology necessary to develop new care models and, importantly, facilitate the digital-delivery of care for patients. He identifies two key tech-obstacles to this: ‘clunky’ systems and a lack of ‘interoperability’. Interoperability relates to the current inability of computer systems/software to exchange and make use of information. Mr. Hancock sees mandatory IT standards and cloud services as essential to overcoming these barriers.
What does this mean at practice level? Resource limitations, ingrained working practices, scepticism and outmoded legacy systems make a simple switch to digital-first systems seem anything from unlikely to impossible. There is much discussion of what the key ‘pinch points’ actually are – with many opinions as to what is needed to move forward along the digital pathway – but what are the actual issues, based on evidence?
Current state of the sector
Patient demand is increasing. In 2016, The King’s Fund published Understanding pressures in general practice in which the authors reported that GPs were dealing with a rising workload, that this workload was becoming increasingly complex and intense and, at the same time, that funding was not growing in line with demand.
These factors are being exacerbated by a shortage of NHS GPs – in part the result of fewer practitioners undertaking full-time clinical work, but also due to large numbers retiring or leaving the profession altogether. Add to this wider system pressures which have resulted in additional, more complex, work falling to general practice to manage and what you have is a system under immense pressure.
In answer to these growing pressures the General Practice Forward View (GPFV) was published by the government. This paper promised additional funding and help for struggling practices; it included plans to reduce the workload and expand the workforce. It announced investment in technology and estates, as well as a General Practice Development Programme to accelerate the transformation of services. However, two years on, general practices are still tackling many of the same challenges, as the British Medical Association makes clear in its analysis, GPFV – two years on.
This is not to say that nothing has changed; technology has become a key focus in the fight to ensure a sustainable NHS. Government initiatives are driving this; for example, the Centre for Policy Studies’ 2018 report, Powerful Patients, Paperless Systems; how technology can renew the NHS, authored by Alan Mak, MP, sets out a plan for a paperless or, rather, a ‘paper-lite’, NHS – calling for pagers, fax machines and paper records to be replaced by integrated digital systems. The vision is that digital transformation will allow NHS services to take back control by fostering innovation and empowering staff and patients – and, crucially, saving time and resources.
The paper outlines three essential targets to be achieved over the next decade:
- to move the NHS from paper-first to digital-first so that 100% of interactions within the health service are digitally-driven by 2028;
- to build an ecosystem of apps and innovation within and around the NHS, to better serve patients and to put them in control;
- to ensure that savings from automation and innovation are ploughed back into frontline services, and that budgets increase for research, development and technology training – at least in line with NHS spending.
That the NHS has been tasked with making £22bn in efficiency savings by 2020 makes achieving these targets all the more important; there is a sector-wide focus on evolving the delivery of services so that they are more efficient and better fitted to contemporary healthcare needs. While visions for a paperless NHS have proved premature, there remains a strong case for document management; digitising patient records, for example, is one way that healthcare practitioners see efficiencies being made.
Managed print services (MPS), scan technology and other efficiency-focused solutions have emerged as ‘must haves’ in a sector seeking to streamline processes, realise efficiencies and improve patient experience. According to industry research MPS, for example, can lower print-related operating and IT costs by as much as 30%. The cost of practice printing is more than the price per printed page; it includes supplies, maintenance, repair and hardware acquisition, in addition to the drain on practice staff time.
This supports the approach that Matt Hancock, who has championed controversial healthcare apps such as GP at hand, has set out in his ‘tech vision’ which is underpinned by a ‘modern technology infrastructure’ to support digital services to meet the needs of clinicians, patients and managers.
The King’s Fund report, Digital change in health and social care (2018), also notes that technology can improve quality, efficiency and patient experience in healthcare, as well as supporting more integrated care to the benefit of the health of a population. In fact, most research will back the potential that technology has to enhance and support healthcare services. However, it must be acknowledged that barriers to digital transformation exist; in Digital change in health and social care, Harry Evans et al turn a spotlight on budgets, attitudes towards risk, workforce constraints and the relationships that exist between care providers and key stakeholders as factors hindering implementation.
The challenge now is to identify how to effectively implement technology solutions to overcome these barriers.
You can read the full report HERE