Former GP, Dr Andrew Whiteley, founder and managing director of a software provider, examines the changing role of the GP and how tech-assisted primary care could look in the near future
The role of GP used to mean being a family doctor 24 hours a day; it involved ongoing relationships with patients and seeing the same faces. We would listen to their concerns, providing reassurance and access to treatment in a timely manner. I look back fondly on my time as a GP – perhaps through rose-tinted glasses – but back then it seemed most GPs could be relied on for help when needed.
Sadly, Covid marked the end of the GP role as we once knew it. ‘Normal’ service never resumed and increased workloads have meant less time to assess new ways of working. We could debate who or what caused such a seismic shift, but our time would be better spent examining the current landscape and identifying opportunities to improve the patient experience and the health of the population – opportunities driven largely by technology.
I would argue that the population’s medical requirements can be split roughly into three groups – the worried well, mental health patients in the community and patients with a chronic condition. These divisions will result in further, permanent changes to the GP’s remit. The effectiveness – and fair distribution – of technology will play a crucial role; I believe patients will eventually be far better off than they are now, if we can get it right.
Monitoring the health of ‘the worried well’
Around a third of patients seeking GP appointments are ‘the worried well’ – those looking for reassurance for mostly minor issues. In the not-too-distant future, I believe these patients will no longer need a GP for this reassurance; technology will have the capability to track, store and monitor our health data in the cloud, alerting us, and medical professionals, to when patterns change, allowing them to then treat or refer us accordingly.
Of course, technology is already helping us track our health more keenly than ever, through the use of wearables like smart watches, and devices we use at home such as smart scales, thermometers, blood pressure machines, oxygen saturation monitors and more. However, they’re not without drawbacks, with many arguing they may exacerbate health anxiety and increase demand for services. Yet I believe there’s the potential for technology and artificial intelligence to play a much greater role in patient health, by capturing all of an individual’s data in one place and monitoring trends. Large data models could then identify potential problems long before traditional healthcare would be able to and act sooner, improving outcomes.
When the need for professional help arises, patients will consult (virtually) with a different practitioner every time, but each professional will have access to all health records, including a patient’s at-home data, and can make clinical decisions accordingly.
The good news is that we’re on a path to this scenario now. There’s already a technology that can detect respiratory rate, pulse, blood pressure and oxygen saturation from a traditional digital camera, and once this is migrated to other devices such as laptops, PCs and smart devices, and integrated with other technologies, I expect smart home devices like Alexa will soon be checking in on our health patterns and offering advice.
I don’t think it’s absurd to envisage a world where home technology monitors how often we go to the toilet, picks up when patterns change, identifies nitrites, white blood cells and blood in our urine and orders a prescription for antibiotics, to be delivered to our home within hours, for example.
Mental health support outside of primary care
My view on the second group may be a contentious, but without the knowledge of patients that GPs once had – the background details, knowledge of family relationships and so on – I don’t believe primary care is necessarily the right place for patients to seek help for mental health conditions.
I think this will be moved into hospitals, with consultant-led mental health teams co-ordinating all support, from acute mental health professionals and community psychiatric nurses, to talking therapies and counselling, etc.
Managing chronic conditions
The other third are patients with chronic conditions. Initially, it made sense to me that management of chronic conditions should remain under a GPs remit. Arguably, care of individuals with conditions such as diabetes, heart disease and cerebrovascular disease requires a health professional to really know patients and understand their health.
However, my mind is being changed based upon an initiative at the John Radcliffe Hospital in Oxford. They previously had four or five people admitted with heart failure every day, now, they have one per month. They have started a nurse-run service, giving patients smart scales and an app to weigh themselves twice daily. When a patient’s weight begins to increase, a nurse is alerted and visits them to take blood and check their urine – if necessary, their medication can be changed following a two-minute conversation with a consultant. It’s such a fantastic example of keeping people healthier with minimal intervention; you let technology do the work for you and step in when help is needed.
What’s left for GPs? A rebrand
Again, it’s perhaps a contentious view and one that will be unpopular with GPs, but I think there will still be a role for them to care for more complex cases of multiple pathologies – maybe under a ‘rebrand’ as community primary care physicians and utilising nurse-run services backed with technology.
So, while nurses will look after those with singular chronic illnesses – asthma, diabetes, heart failure, etc. – patients with two or more chronic diseases will require higher level care. It’s possible that entrepreneurial GPs will set up services and offer their expertise more widely, in the same way hospitals are. Time will tell.
Accuracy and accessibility will be vital
My predictions will only play out successfully if tech capabilities can ensure accurate recording, and the sharing of data amongst healthcare practitioners. It will be more crucial than ever for staff to take the knowledge gained from every patient interaction, and ensure it is recorded in as much detail as possible. IT solutions can help save time – and money – on this.
It’s also important that patient technology is accessible for people of all ages and backgrounds to use. Not everyone will have (or want) an Apple watch or a smart speaker at home, but, as shown by the John Radcliffe initiative, monitors and other tech equipment can be easily bought and loaned out. This could potentially save the NHS tens of thousands of pounds in treatment costs – and ultimately save lives whilst we wait for more integrated and ubiquitous tech to emerge.
Dr Andrew Whiteley is founder and managing director of a digital dictation and workflow software provider Lexacom.
