Dr Murray Ellender is the co-founder of eConsult and a GP partner in the Hurley Group GP partnership, South London. He speaks to senior reporter Jess Hacker about ICBs and digital transformation
Why is there so much variation in the NHS when it comes to digital transformation?
The NHS has been quite good at procuring the technology – paying for the tech – without thinking about the transformation that needs to go with it, and that leads to real variation in how it’s used. The result is relying on a practice or PCN to do the transformation work itself. Some practices will do that but many don’t because they need help.
There’s no point having digital tools if practices don’t use them very well.
The transformation piece is key because what we’re asking general practice to do is really change fundamentally how it works, moving from a system where most patients were seen face-to-face to one where most practices will now offer some kind of telephone triage. But telephone triage is more inefficient, because staff have to ring everyone back – you need to move toward online triaging.
Practices need transformation funding: a one-off cost surgeries can invest to ensure they use these tools effectively. That’s crucial at a PCN level when you’ve got networks asking practices to not just change their model of working but also learn how to work as a group of three or five. Digital transformation leads are a good example of that investment.
What can ICBs do to improve digital transformation at system level?
We should be doing a lot more of it. [ICBs] need to take a step back and ask do we really use digital tools well in healthcare? No. Compared to other industries healthcare underuses it. The NHS doesn’t spend enough on the transformation that’s needed to make sure these tools are used. But ICSs would likely say that they don’t have the central funding to deliver that transformation.
And it’s not just digital access, there’s lots of areas that need transforming – long-term condition management is a key one.
If it’s serious about embracing technology, the NHS as a whole needs to spend more on that transformation aspect, otherwise it will continue to not use the technology it procures. That’s a shame because we need that tech to plug the gap in staff. The workforce we need in general practice isn’t coming soon.
In June, the Health and Social Care Select Committee praised the NHS’ digital ambitions but criticised its repeated failure to realise them. What’s got to change for the future?
Digital transformation is hard. We are fundamentally changing how patients access general practice. When something the NHS tries doesn’t work, we can’t say, ‘We tried that, it didn’t work out, let’s go back to the old way,’ because other sectors and industries have pulled it off: we need to learn from what has gone wrong over the last few years.
We’ve underinvested in digital tools. It seems the new primary care access recovery fund is going to properly invest in digital tools, [which means] the transformation to support that. We will have to see how the next couple of years go, but the NHS is now putting some more money on the table to help people drive transformation.
That’s the right thing to do but I’d argue that’s still not enough investment. Estimates for how much of NHS England’s budget is spent on digital point to 2% to 5%. And most of that goes on hospital electronic health records (EHRs). When you look at other industries like banking or retail, some of them are spending up to 20% of their revenue on technology and that’s helped make the whole system more efficient.
Are ICSs too large to tackle that variation at practice level?
ICS level is a bit too big to achieve that transformation, and it should be done via a smaller unit. An ICS will have a real mix of practices who use digital tools well and some just don’t. How to get these practices to learn from their peers is a tough question to answer – and it’s a question we in the NHS haven’t cracked. ICSs can’t mandate it – they can’t tell a practice they have to use this or that tech, it just won’t work.
Some practices will have a population more receptive to digital healthcare. How does the NHS address the variation at a patient level?
We have to be cautious about blanket statements. There might be a tendency to say a practice Eastbourne, for example, won’t accept digital appointments because the population is mostly elderly, when that really isn’t the case.
There is a proportion of people who aren’t very digitally adept but about 90% of the UK population is now online and around 75% are comfortable online. But when you look at most practices or PCNs, they’ve likely shifted about 10% of their activity online. That means there is a huge opportunity to get the 75% who are adept to interact with their practice remotely or digitally: they will be comfortable using appointment booking and messaging systems.
There is the question of health inequality but if you move your digitally capable patients online, it should make access to other routes easier. Rather than funnelling everyone through the reception phones, you can free up phone lines for your less digitally adept patients.
There are plenty of patients in their 60s, 70s and 80s who are comfortable using this, not all of them clearly, but that doesn’t mean these tools don’t work in certain areas with certain people. We haven’t done enough to shift them online yet.
