The NHS Five Year Forward View fired the starting gun for a new generation of integrated care systems. And NHS England chief executive Simon Stevens has made clear that if your organisation wants in, there is one thing you absolutely must have in your kit bag: the ability to connect patients with doctors and nurses using 21st century communication techniques.
This is not about clinical or back office systems. We are talking simply about the web, the telephone and apps – the same things we use in our day to day lives to connect with friends, families, work and services like banks.
This applies whether you are a primary care organisation thinking of becoming a “multispecialty community provider”, a hospital contemplating vertical integration with GPs to become a “primary and acute care system”, or you want to go all the way and become an integrated care organisation providing all the care to a given population with a delegated capitated budget.
Take a look at what the forward view actually says: “There is broad consensus on what the future needs to be… a future that empowers patients to take much more control over their own care… a future that dissolves the classic divide… between family doctors and hospitals… one that no longer sees expertise locked into often outdated buildings, with services fragmented, patients having to visit multiple professionals for multiple appointments, endlessly repeating their details because they use separate paper records.”
In short, the future is self-management, integration and patient centred care. These require closing distances, crossing boundaries and increasing collaboration – all things that digital communication does best.
We have been delivering exactly this way of working with Birmingham’s GP “super practice” Vitality Partnership. This serves more than 60,000 patients and was cited in the forward view. Vitality recently launched Health Hub, a flexible service allowing patients to make contact via an app and consult doctors by phone, Skype or face to face. At the moment, the service is conducting 75 per cent of consultations remotely – a dramatic change to supply and demand. We can use that experience to translate the forward view vision into concrete actions. Patients need to have real time internet access to doctors and nurses from a range of locations, digital access to consultant level expertise, and an electronic care plan they can manage themselves.
Real time internet access eliminates treks to the outpatient clinic or queuing up in the GP surgery for a rigid eight minute appointment that is invariably either too long or too short. Digital access means consultant advice that once was available only in a hospital setting can be sent to a patient’s smartphone for them to read at a time of their choosing.
Patients no longer rely on the system to join up because they can join it up themselves through ownership of an electronic care plan, which they can share with relevant healthcare professionals regardless of organisational boundaries. Such care plans can also be shared with friends, family and voluntary organisations, exploiting what the forward view calls the “renewable energy” of the community. This is simply what happens anyway in the real world. Patients come home from the GP with a prescription and some lifestyle suggestions. They share these with friends and family who support them to stick to the doctor’s advice. By digitising this sharing process you can expand its value.
Many people in the NHS are wary of such developments. If all this data were out there being shared in the community would there not be data governance implications and security risks? Actually, no.
I am not talking about giving patients access to their NHS electronic patient record. This is a business tool and far from user friendly.
I’m saying we need to create a separate record in the form of an electronic care plan. This captures the patient’s health journey much more comprehensively. It records all aspects of health and wellbeing including life events, goals, aspirations, and data from personal health devices such as wearables – a true personal health record. The patient then decides whether to share it. Health professionals see both the NHS version and the highly personalised patient version, as long as the patient permits access.
Wrapping up all these changes together creates an environment in which the NHS can transform its business and clinical models in line with the forward view and provide a quite radically different service to the citizen.
Unlike traditional heath technology, this is a genuinely transformational approach. Clinical care is a critical element but it is not the be all and end all. Doctors and nurses fit in to the patient journey, rather than the other way round.
‘The forward view acknowledges the significance of citizen facing technology’
This is not a pipe dream – it is happening in Birmingham right now at the Vitality Partnership.
When the forward view says “we will raise our game on health technology – radically improving a patient’s experience of interacting with the NHS”, it acknowledges the significance of citizen facing technology. Not back office systems, not clinical black boxes, not big data – although they have a place.
Just the good old internet, phones and apps, used to make health as accessible for people as it should be.