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Gerada calls for ‘national drive’ on telehealth

Gerada calls for ‘national drive’ on telehealth
1 July 2011

The Telehealth Summit 2011 was hosted by the Royal College of GPs (RCGP) and healthcare think tank 2020Health earlier this week (28 June) in central London.

The Telehealth Summit 2011 was hosted by the Royal College of GPs (RCGP) and healthcare think tank 2020Health earlier this week (28 June) in central London.

The event brought together forward-thinking GPs, technology experts and government figures who spoke on "how to transform patient care" utilising such means as remote monitoring, e-consultations and shared electronic record access.

2020 Health estimates that effective adoption of telehealth could save the NHS £1bn per year, as remote monitoring and relay of health information reduces challenges presented by the increasing number of patients with long-term conditions and the elderly.

The government has earmarked £530m to ensure 90% of the UK can access superfast broadband by 2015. David Hendon, Director of Information Economy at the Department of Business, told the summit that such investment would support the adoption of telehealth and more electronic consultations across the country.

GP Business spoke to RCGP Chair Dr Clare Gerada, who opened the summit…

Why is today important?

This is the first e-health conference held by GPs inviting the major players. We're now driving the agenda – the RCGP is unbelievably excited about helping our members to use this technology. What we want to get over now is not, 'Does it work?', but, 'How can it work in practice?'. We want not to bombard GPs with additional workload but actually to see how we can make this improvement in patient care and reduce consultations. When we surveyed our members recently about the Health and Social Care Bill, one of the things that really stood out – that made me excited – was innovation. And this is about innovative practice.

Is the government doing enough to support telehealth?

No, I don't think the government is doing enough. We spent 7-8 months discussing the Health Bill when we should spending 7-8 months discussing how we can use modern technology within existing services to improve patient care and address the issues around long-term disease. This needs a national drive – this can't be done through 384 consortia. The infrastructure and investment requires a national push. This isn't about a shared electronic record – this is about using e-health right from the very simple uses – eg, texting directly to district nurses when patients are discharged from hospital – through to the extreme other end of helping to do management of long-term disease in patients' homes.

Not all patients have access to computers and, even with all the investment the government has pledged, not all will have access to superfast broadband. Could these inequalities risk two-tier healthcare access?

It's not just about using broadband – e-health now encompasses the telephone, the mobile phone as well as the internet. I live in an area with superfast broadband but our wi-fi breaks down 10 times a day so clearly I couldn't rely on our wi-fi in our own home to give me renal dialysis if I needed it. But it's about using the appropriate technology as it currently fits with patients to help deliver better care. So again, at its simplest it's sending text reminders – a lot can be done even with hand-held electronic devices. For me personally, I'm very excited about this. I know nothing about technology, but when I started to look at it I realised the potential of this in adding to patient care – not driving it, but being used as an adjunct to patient care.

Is there a danger that remote monitoring removes the human contact aspects of GP care?

Yes, and I think it's really important that we never, never, never underestimate the simplicity of the touch – of patients being held, [having their] hand held, [of being] touched when they're examined, and also the face-to-face contact. But this is about adding to that, not about subtracting from it.

What with the proposed removal of practice boundaries next year, is remote monitoring part of a general trend towards a greater distance between patients and their GPs?

No, this isn't going to make it easier to have no boundaries. When people are sick, they still need to access a doctor who understands them, close to home, and when people are sick they don't want to be travelling 200 miles away. And also we need to understand how to use resources: I don't know how to tap into district nurses' resources in Scunthorpe when I live in London. So I think [telehealth technology] is about additive [care], but clearly patients can be more mobile, so maybe there are ways of addressing the commuter problem if GPs embrace Skype technology and contact their patients online. You can still have your GP close to home but if you're travelling it can help in that way.

You spoke earlier today of general practice not having changed significantly for a generation, and the need to modernise. Is there a danger that the uptake of technology could lose the good aspects of traditional general practice?

We have to preserve the consultation, which is the absolute centre of what GPs do. That consultation really can't be replaced, but what we can do is add to it through e-health. So I keep in contact with my patients through text and through them emailing me. But mainly it's about short interventions and then I see them face-to-face for the more, if you like, serious work that we need to do together. But we've arranged this and we've put in safeguards – anonymise the patient's name, etc – but it doesn't detract from me being their doctor and seeing them face-to-face. And as I said, patients when they're sick want to be able see their doctor. Of course, technology can add to that but I don't think it's going to take it away.

You suggested earlier that the Health Bill could be an opportunity for GPs to increase the uptake of telehealth. How?

I think the Health Bill and the savings – the cuts – are two different things. I think the cuts, [which] can parallel alongside, may not allow us to embrace new technology because even though it will eventually save money, new technology will cost money to invest in. But if you take the Health Bill as it stands – or as it stood before the amendments – if it's about GPs being able to design services that best meet the needs of their patient population then it should be about doing things differently. It should be about recruiting more GPs, having more GPs in the community, but it should be about redesigning services to better use of remote technology and e-technology.

Who should be leading on driving telehealth uptake – GPs or technology firms?

Technology companies can help us and clearly can see what the opportunities are – they will know, for example, that we can do remote monitoring of people's blood pressures but actually that's not the really important bit, which is how often should you monitor, how do you interpret it, how do you stream it into the GP's consultation. We don't want to be sitting in our surgery and having endless streaming of information – say, a mother taking the temperature of her child every five minutes. So I think [technology firms] can design the technology, rather like they designed mobile phones, and then it's the users that help them shape that. And I think the users are the GPs, other doctors, health professionals and patients.

What's the current national uptake of telehealth among GPs?

For telehealth I think it's very little. I don't have figures for it, but just anecdotally it is very, very unusual I think for GPs even to use email and text in consultations. We do use text reminders now, and a lot of practices have engaged with that, but in my own experience a large number of practices across the country don't use it. Clearly we use new technology through path links and electronic prescribing and through our use of electronic records, but beyond that I don't think we're using it very much.

Do GPs need to drive this forward?

Yes, but I think this is the sort of thing that really requires national leadership. I think GPs are hungry to move things on but it requires national funding, because the 'techy' stuff requires money, the equipment requires money. And it will require investment. So that's number one. Even putting superfast broadband in people's homes requires investment. So the technology requires national leadership, national excitement and then GPs and folk like me to support it and say, 'Let's try it and see how it works'. It's exciting stuff, really.

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