Online Consultations and the strategic vision for Primary Care in London Dr Jonty Heaversedge and Dr Sian Howell UCL Partners 20 th September 2017 1
Contents 1. What are our biggest challenges in Primary Care? 2. How might Online Consultations be part of the solution to these challenges? 3. What risks do we need to be mindful of? 4. What do we know from existing research? 5. The national vision for digital Primary Care 6. Where are we now in London? 2
What are our biggest challenges in Primary Care? Stretched capacity Stand alone systems (Online booking, clinical systems, prescriptions ) Digitally Immature Variance in service approach Inconsistent comparative activity data Varied funding Siloed working Immature supporting digital infrastructure Limited integration across community based care (Social prescribing, community mental health..) Staff retention
How might Online Consultations be part of the solution to these challenges? General Practice is already more digitally mature than many other areas of the system. Online Consultations have the potential to continue this development and support innovative new ways of working, which could deliver significant benefits to patients, clinicians and the wider health system For patients For clinicians The ability to access their GP using a variety of tools, in a way that works for them, and at a time that suits them Greater flexibility and control of their health and care needs with advice available 24/7 with the ability to manage repeat prescriptions and access medical records online Help for patients with mobility challenges, who may struggle to visit the practice for a face to face appointment For patients who do not speak English as a first language, symptom checking / sign posting functionality could help to improve appropriate triage to services relevant to their needs A more flexible workforce, allowing GPs to work from home and offer those who wish to get back into practice opportunities to work more flexibly Improved capacity management and workflow optimising the utilisation of clinician time Potentially more proactive care for more vulnerable or housebound patients Enhanced multi-disciplinary team working Greater system efficiency and productivity through the development of innovative new care pathways The ability to work collaboratively to manage demand e.g. through Federations offering 8-8 appointments, 7 days a week via the provision of a digital alternative to visiting the practice Empowering self-care by connecting with alternative resources/support
What risks do we need to be mindful of? As with anything new we have much to learn. Introducing online consultations will, of course, be a huge challenge, as well as creating new opportunities, there are risks for GPs and the system. We will need to work in new ways to ensure that new technology is implemented successfully, and are aligned to our wider aim of high quality, accessible, coordinated, proactive general practice. Our biggest risks include. A rapidly growing, complex and fragmented digital market, with 106 new entries in the last quarter alone, all of which with potentially limited interoperability Inconsistent offer for patients - multiple pilots taking place across London, with different approaches Destabilisation of general practice, an erosion of core attributes of care and the personal, comprehensive, community orientated provision of care Poor quality data on existing appointment utilisation, or best evidence regarding who might benefit from new technology, and who might not Uncertain costs and procurement routes for digital services, with potentially high up front capital costs Quality concerns challenge to quality and governance frameworks to keep up with new systems of delivery Risk that easier access may fuel unnecessary demand Risk of increasing inequalities in provision and, as a result, create new inequalities in outcomes Effective implementation is dependent on changing the way we work systems and processes at practice level 5
Learning What can we conclude? Online access portals potentially useful in diverting high volume of consultations from younger population As time goes on may be more useful for older populations also Need to think about practice demographic and digital inclusion Important to expand evidence base for these platforms Data is powerful in terms of business intelligence Understanding the market important to inform service development
Meanwhile, the digital health market is complex and growing quickly 7
8 The national vision for digital Primary Care We must work closely with colleagues across the health system to ensure that the long term digital agenda for Primary Care is aligned with and supports UEC, Self Care and other digital developments Our aims today Tomorrow And in the future Primary Care UEC Online Consultation Wi-fi Patient Online NHS 111 Patient Relationship Manager NHS First Online Consultations 111 Online Online appt booking GP and GP Hub appt booking from 111 Shared patient records EPS integrated with 111 & GPOOH Enhanced clinical 111 triage * 5 6 7 GP service for HCPs NHS Online Self care & prevention NHS Choices Apps & wearables NHS.UK LHCIE Technical enablers Personal Health Records Citizen ID Population Health
The national vision for digital Primary Care Today Tomorrow The Future Ability to register online Book appointments (in hours) Manage & order repeat prescriptions Access to your medical record Share your medical record (family friends and other members of the MDT) Develop your own personal health record (pulling information from apps & mobile phone) Directly message your practice Ability to update your contact details online AI Symptom checking Intelligent triaging Booking of appointments 24/7 Online consultations Face to face consultations Integration with clinical health systems for clinicians Precise, proactive population health management through use of data analysis and machine learning Virtual ecosystems (virtual wards, virtual general practice, virtual waiting rooms) Remote monitoring of long term conditions through telehealth and telemedicine Genomic technologies to predict and where possible prevent disease / illness 9
Where are we now in London? DEFINITION LONDON PROGRESS Patient Online Online access to GP appointments and patient records 30% of London GP appointments currently online Advertising campaign reached millions of Londoners 111 Online 24/7 access to 111 and UEC services via a self-triage app 111 Online pilot live in NCL since early 2017 Will be live in 3/5 London STPs from Dec 2017 NHS Online Standardised website and mobile app bringing together appointment booking, triage, consultations and 111 / UEC NCL and SEL (Bexley) pilots are being developed SEL service due to launch in early October Wi-fi Rollout of wi-fi in GP practices Funding allocated to CCGs earlier this year and rollout for Dec 2017 delivery underway Electronic Prescription Service Electronic prescriptions and medicine dispensing for GPs and patients, as well as integration with 111 and UEC London on track for 72% of practices live by March 2018 Integration with 111 being rolled out across London in 2017-18 Electronic Referral Service Paperless system for GPs to refer patients electronically into secondary care North Middlesex and Wittington will be the first trusts to Go-Live at end 2017 All London trusts live by April 2018 LHCIE (London Health & Care Information Exchange) A safe, scalable tool for sharing patient data across health and care organisations On-track for Go-Live in Oct 2017 Data control console for managing Information Sharing Agreements (ISA) live in over 200 organisations
Questions? 11