Reports on technology from NHS Confederation 2012, including health secretary Andrew Lansley and pioneering Bradford GP Dr Shahid Ali. I blogged about the conference less seriously here.
“Through telehealth, it’s not just the technology, it’s the ability to redesign the service,” Andrew Lansley told the NHS Confederation’s annual conference last week. The health secretary also praised other methods for providing healthcare remotely, including the 111 advice and out-of-hours services that are being extended across England.
Over the last few years, the Department of Health has run a large-scale test of telehealth, the whole system demonstrator programme, involving 6,200 patients in 238 GP practices in Cornwall, Kent and the London borough of Newham. It found benefits included a 20% cut in emergency admissions, a 14% reduction in elective admissions, and savings that, if replicated nationwide, could reach £1.2bn over five years. A study just published by the British Medical Journal reports that those with chronic obstructive pulmonary disease, diabetes and heart failure who had access to telehealth under the programme similarly had fewer hospital and emergency admissions, as well as reduced mortality rates.
But Lansley made it clear that on this, as with other things, it will be up to local NHS organisations rather than central government to bring in change: “I believe this leadership will come from within the service, not be imposed from outside,” he said in his keynote.
A conference fringe session on telehealth heard from Dr Shahid Ali, a Bradford GP who is providing exactly that kind of leadership. He has two monitors on his desk: one for accessing software such as patient record systems, the other for remote consultations, initially used with one care home in the surgery’s patch. “There was a 70% reduction in the number of visits we had to make to that care home,” he told the audience, while residents and managers loved it and doctors saved a great deal of travelling time. “We have now expanded it to all the care homes in the Bradford and Airedale area.”
Ali, who is also the NHS National Commissioning Board’s clinical lead for patients and the information directorate, sees remote consultations as just one part of reorganising general practice. His surgery has replaced clinics for individual conditions with blue and red clinics, which give those attending 30 or 60 minutes respectively to discuss and set up self-care plans for all their health conditions – many have several, and dealing with the patient makes more sense than dealing with each of their conditions in separate sessions. Setting up self-care empowers patients, Ali said: “They love it, they want to have the responsibility to do that.” They also visit their GPs and accident and emergency less, saving a surgery with 10,000 patients £1.5m a year, he added, freeing time for doctors and other staff to provide better care.
The surgery has also found ways to make life easier for both doctors and patients by sharing records electronically between GPs and consultants. “I have known people who have died waiting for an appointment. That system needs to change,” said Ali. So the surgery shares records, allowing consultants to email a provisional opinion within 24 hours. This either triggers an urgent appointment, or reassures the patient that their condition can be managed in the community. As a result, patients do not see the need to go to A&E in the meantime, as they know they will get a swift response. “We will eventually change completely to that way of working,” said Ali.
Ali said that technology will change medicine further, such as having consultations via smartphones – a technology already being used by private provider Circle Healthcare for internal management. Its chief executive Ali Parsa showed a conference session an app that cost £2,000 to develop and gives staff access to internal waiting time data, which Parsa said has helped reduce these times to near zero.
Ali said that it is time for the NHS to introduce substantial changes across the country. “We’ve done enough pilots,” he said. “I’m sick of pilots. We need to scale this up.” Clinical commissioning groups, which will take over primary care next April, should lead the way, he believes.
But he added a warning for those thinking that technology alone can solve NHS problem, with his changes ranging from high-tech ones like remote consultations, to low-tech ones such as the blue and red clinics. “This is not about the technology,” he said. “The technology is there to support us, to help us move forward.”
SA Mathieson is a senior analyst for public sector market intelligence service Kable
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