Primary Care is the backbone of our health & care system. By some estimates approximately 85% of all patient contact across the NHS in the UK, occurs in Primary Care. Similar statistics abound across the globe. At GE Healthcare Partners, we believe that genuinely transforming health outcomes for a population requires a robust and resilient Primary Care system that is aligned to the needs of the population; integrated fully into the care pathway and empowered with the support, tools & resources it needs to improve people’s lives and help the system save time & money.
We also know that Primary Care is full of clinicians who are innovative, entrepreneurial and/or have insights to share. In this forthcoming series of articles we want to provide a platform for those who have visions for what could be different in healthcare leveraging technology and what can be done to accelerate the diffusion into mainstream services.
Most experts agree that effective Primary Care is essential to a strong healthcare system. The clear majority of patient care is delivered by Primary Care practices, and many studies have shown that general practitioners play a key role in optimising patient outcomes.
Yet when it comes to solving problems in healthcare, most leaders focus on hospital-based solutions. Hospitals are seen as the centre of innovation and thus receive the lion’s share of investment. Solutions based on strengthening Primary Care receive less funding. In part, this is a practical consideration. It is a lot easier to work with a few hundred hospitals than it is to engage with thousands of GPs. Yet I believe that by ignoring primary care, we are missing an opportunity to genuinely improve outcomes for the population. Over the last few years, I have met many primary care leaders who are finding creative ways to overcome major challenges in healthcare delivery. In fact, one practice I recently worked with used the most basic tools to solve a major capacity problem. This group shows that with the right support, Primary Care can lead the way in crafting innovative healthcare solutions solutions.
Case Study: Using simple tools to design new delivery model
A group of four general practitioners in the North West of England was experiencing patient volume increases of about 5% per year. This surge was not only leading to longer wait times, it was putting increasing strain on the workforce. One obvious solution was to hire new general practitioners, but despite their best efforts the group was struggling to recruit new GPs.
I began working with the group’s practice manager in 2016. My first step was to harvest three years’ worth of data from the appointment management system. I then used a commercially available spreadsheet software to create a simple data modeling tool. The tool allowed the practice manager to analyse the daily flow of both patients and providers. It also let her model the effect of different workforce scenarios.
As I worked with the practice manager, I was struck by her tremendous drive to ask questions and explore the data. Some enquiries took her down rabbit holes, but many others led to powerful insights. At the end of the process, she was able to present her partners with several innovative solutions for how they could use workforce differently in the practice to address their challenges.
First, she recommended against adding another GP. Instead, she used the data to demonstrate that hiring a pharmacist would significantly alter the practice’s “capacity curve.” She also recommended expanding the role of physician associates and showed how this would work in practice.
These simple changes allowed the group to significantly increase the number of appointments available each week. It even enabled the practice to explore shifting some GP appointments from 10 to 15 minutes, a proposition that was welcomed by both patients and GPs. Just as important, all these improvements were realised within the same financial envelope. The practice increased capacity and improved service without blowing the budget.
My 'a-ha' moment
To be clear, workforce redesign was just one element of the change implemented by this group. The practice manager also used the data model to identify and manage high-risk patients, and through her ingenuity and that of her colleagues, the practice worked to secure contracts for health improvement trials. So this was a practice that had a culture of improvement.
However, it is worth noting that her efforts achieved breakthrough change without complex improvement methodologies, advanced technology, artificial intelligence or any of the other sophisticated tools we typically associate with healthcare innovation. For me, this was an “a-ha moment.” I realised that given the right opportunity, local primary care practices can take on big challenges in healthcare. Many primary care leaders are inspired by what the future could be, and they have the ambition to shape very different models of care that can help us build a much better healthcare system.
But the key is opportunity and the right backing.
Following are three observations on how healthcare leaders can provide primary care innovators with the support they need to unleash their drive and creativity.
1. A bottom-up approach is essential
Too often we look to policy makers to solve problems in healthcare. As we work to engage primary care in healthcare innovation, we must recognise that practice leaders themselves are in the best position to identify realistic opportunities and devise sustainable solutions.
The practice I described above is a case in point. It is quite likely that any workforce solution imposed from the top would have created as many problems as it solved. But as it played out, local expertise was empowered to explore different staffing scenarios and select the option best suited to the practice’s unique situation.
How can the “big players” in healthcare support this kind of bottom-up innovation? One of the best ways is simply to educate practice leaders about what technologies and resources are available. The more practice managers know about new tools that can help them address their practical challenges, the more likely they are to use them to devise innovative solutions.
2. Technology is not enough
Recently, a group of my colleagues led an initiative to improve newborn care in Ethiopia. The community they worked with had little healthcare infrastructure, so the question was not, “How do we work within the existing structure to improve services?” — but, “How do we set up the right primary care infrastructure to truly change people’s lives?”
They ended up collaborating with local leaders to build a full range of systems and processes to support the use of technology in neonatal care. These included provider education, clinical capacity building, process design and financing. In the end, the initiative succeeded in achieving a 24% reduction in neonatal mortality and about a 50% reduction in outside referrals.
Obviously, the situation in other parts of the world varies, but this experience teaches a critical lesson that is true whether you are in Ethiopia or Surrey: To achieve healthcare innovation, technology is not enough. You also need to create a business model that enables the services to be scalable and sustainable.
Again, this represents an opportunity to support innovation in primary care. Most practices need help in assembling the pieces of a viable business model. In my team’s experience, the five essential ingredients are technology, capacity, service, evaluation and finance. It’s through combination of these that we will help Primary Care innovators achieve game-changing outcomes.
3. Primary Care does not need philanthropy, it needs partners
In the U.K. as elsewhere, efforts to improve Primary Care often focus on pilot programs backed by special funding. The problem is that this approach usually fails to create systems that can survive after the money dries up.
Primary care practices do not need our philanthropy. What they need is organisations that are willing to partner with them to create value at scale and in a sustainable manner.
Consider this scenario: A Primary Care practice decides to partner with a technology company to improve cardiac health in its community. Ultrasound diagnostics are a key element of the initiative, but the parties purposely eschew a “transactional” relationship that simply involves an equipment purchase. Instead, each party commits to contributing whatever is needed to achieve the defined goal. Under this scenario, the tech company not only provides equipment, it also contributes capital, data analytics support and expertise in process improvement. This entire “transformational” relationship is underpinned by a multi-year, value-based contract that allows the practice to access all the resources it needs to achieve the target outcomes.
We are backing Primary Care
Working alone, Primary Care providers have been very successful at developing small-scale innovations. Just imagine if healthcare leaders committed to backing the ambitious pioneers in Primary Care. Through partnerships, we believe it is possible for Primary Care to scale up it’s impact and deliver large-scale innovations that create a better healthcare system and have a dramatic impact on people’s lives. This however, requires us all to have the courage and imagination to back leaders in Primary Care.