“Significant resource” in both capital and running costs for technologies are needed to support primary care among dwindling numbers of GPs across the country, a report has found.
The Nuffield Trust report, Delivering general practice with too few GPs, found a focus on technology that supports patient triage and diverts pressure from GPs was needed, alongside the development of local processes to prioritise which technologies will provide the greatest value.
Online triage; remote consultations; and remote monitoring and self-management support were pegged as the three areas that will make the biggest contribution to general practice.
An increasing number of GPs are leaving clinical practice with many practices struggling to fill vacant posts. The shortage of GPs is becoming “chronic”, according to the report.
Researchers at the trust asked clinicians, managers, policy makers and researchers who participated in a workshop to consider the opportunities and barriers associated with wider implementation of existing innovative services.
They found online symptom checkers, apps and e-consultations are helping provide advice to patients “allow some administrative problems to be steered away from clinicians”, but could also drive up the number of patients seeking advice.
“While online symptoms checkers and triage systems have the potential to avoid clinical contact completely, if programmed to be risk averse, they may recommend professional assessment for relatively small problems that could be self-managed,” the report said.
“Hence, they may drive more patients to seek professional help.”
A “variable appetite” exists for technology and digital health solutions, primary among younger people, but face-to-face appoints still remain the “gold standard” for many patients.
The group called for patients and carers to be involved in all aspects of designing and implementing technologies that will be used in practices, but warned clinicians need to be given the time to learn how to use the digital tools.
“Given the competing demands of other high priority service development in general practice (such as forming networks, improving access and developing new staff roles), it is essential to identify and prioritise technologies that will add greatest value to patients, clinicians and practices in a given local context,” the report found.
A “national blueprint” of new forms of general practice should be avoided to allow development at local and borough levels in order of services to be tailored to a population’s specific needs, it added.
The new GP contract agreed between NHS England and the British Medical Association’s (BMA) GP committee in January gives practices almost £1bn across five years to help fulfil ambitions laid out in the NHS Long Term Plan.
This includes all GP practices offering online consultations by April 2020 and making at least 25 per cent of appointments available for online booking by July this year.
Practices are also expected to provide all patients with online access to their full medical record also by April 2020.
The four priorities identified for the introduction of technology in the face of too few GPs:
- Focus on technologies that can support patient triage and divert patients away from GPs if they have administrative needs that can be dealt with by clerical staff or clinical needs that can be effectively managed by other clinicians or through self-care
- Develop local processes to prioritise which technologies will provide greatest value to patients and to staff and phase their introduction to avoid overwhelming patients and staff with too much change at the same time
- Involve patients and a wide range of practice staff at every stage of work to develop and implement digital and other technologies, including which type of technologies to introduce, how they can best be implemented and how information about them should be communicated
- Invest significant resources in both capital and running costs for technologies to support general practice, and invest in the training and organisational development needed to ensure they are used by staff and patients once they have been introduced