Covid-19 forced the NHS to accelerate a move to remote ways of working – and the resulting transformation is something that health secretary Matt Hancock wants to see stick.
He’s told GPs to make remote consultations the default option ‘unless there’s a ‘compelling clinical reason’ not to – and believes ‘Zoom medicine’ is key to moving forward after the pandemic.
But how can the health service maintain the rapid digital changes it has made so far? Healthcare Leader spoke to Dr Taz Aldawoud, a GP and chief clinical information officer at NHS Bradford District and Craven clinical commissioning group (CCG), to get his take on it.
‘The healthcare system reacted very well [to the changes forced by Covid], but in terms of digital maturity I think we still have a long way to go,’ Dr Aldawoud says.
‘Many of the changes in the last few months have been the low barrier, easier to implement things, which were expected years ago.’
Dr Aldawoud, who is also the founder of Doc Abode – a start-up that enables healthcare providers to recruit clinicians flexibly and according to patient need – believes more needs to be done to ensure real sustainable change around how the NHS uses technology, but he’s clear on one thing – it cannot revert back to normal after Covid-19, as that would be ‘a huge waste’.
‘We have to consider how we can maintain this, and I think it’s through collaboration with change management experts,’ he says.
Dr Aldawoud’s CCG works closely with GP federations and trusts, to bring the ‘right groups’ together to have these discussions – covering topics such as how to manage demand, make care pathways more accessible and measure patient experiences and feedback of new systems.
To inform these conversations, organisations should look to evaluate the impact of digital changes that have already been made, he says.
This includes gathering more data on how efficient telephone consultations are compared to video, and the outcome for patients of using both, in order to determine how well they work and understanding when it is more appropriate to consult in person.
Data from NHS Digital gives some indication of how the landscape has already changed when it comes to GP appointments. Figures show that in August, 52% of all appointments in England were face-to-face, 43% were over the phone, and 0.4% were by video or online. In the same period last year, 80% appointments were in-person, and just 14% over the phone.
Dr Aldawoud says the NHS now needs to determine whether this shift has led to clinicians diagnosing certain conditions more than others – and how it impacts prescribing levels for certain medication, and the overall short, medium and long-term impact of that.
‘I think that information is sat there within the record system, and the question is how do we anonymise and collate it to make it meaningful,’ he says. ‘We need unique identifiers in every single data set, so we can follow a patient’s journey through the healthcare system, which allows us to see where they have ended up and how those changes have worked.’
This wasn’t all possible at the start of the pandemic, as healthcare providers had to be proactive in making those changes, Dr Aldawoud adds, but now is the time to analyse that information.
His suggestion is that providers need to start building up the evidence ‘in a pragmatic way’ so within three or six months, they can know whether or not the change has been effective.
‘If something is going really well, brilliant, let’s amplify it and get it out there. If things aren’t going quite to plan, do we understand why they’re not working?’
Dr Aldawoud is also very conscious of health inequalities, but he thinks that ‘the right tech’ can help narrow that. His CCG is currently talking to a company that provides bilingual labels on prescriptions at the pharmacy, which he says has been shown to improve adherence.
‘The NHS needs to ensure that by implementing technology, it is not increasing the divide among deprived populations, the elderly and those who do not speak English as a first language.
‘We must consider how we focus on people who need it most, as not everyone is going to find using video consultation useful or have all the kit to do that.’
This includes doing more work to ensure groups, such as much older or vulnerable people, are not left behind in the digital transformation, Dr Aldawoud says, with helping people get online a part of the solution.
‘It’s not always about the shiny new things we know are out there,’ he concludes. ‘It’s about the things that are absolutely essential to deliver improved health outcomes for patients – but we also need the tools to validate, test and scale up the right innovations quickly.’