This article was written by Dr Neil Paul, a Practicing GP. Dr Neil Paul has numerous roles; a board level executive for CCICP, a management consultant working with GP federations and an IT guru well known for speaking and writing articles on innovation in Primary Care.
I think it was Einstein who said “Insanity is doing the same thing over and over and expecting different results” Makes you wonder if he’d come across the NHS?
I was at a meeting the other day where we were being told that getting bigger was the answer. I’ve lived through health authorities, PCGs, PCTs. Bigger PCTs, PBC, CCGs and now all the talk is of STPs, ACOs, ICPs etc. Interestingly, one of the sensible voices at the meeting stated that previous changes had just been in the size of commissioner and what was different about this reorganisation was that they were trying to reorganise the providers as well.ACOs or ICPs give the problem (not enough money) to the providers to sort and there is much talk from managers of how aligning incentives and having one pot of money will make a difference. That we won’t all be competing, we will be cooperating.
Sounds good? It is if it happens.
So what is needed? Well for me Einstein is right – we need to do something different. I also believe John Seddon is right in that we need to remove failure demand from the system. Without getting too technical or precise, failure demand is all the contacts or processes in a system that add no value.
One of the biggest sources of waste and an area that is ripe for disruptive innovation is the interface of primary care and secondary care. Why have waiting lists for out-patients? Perhaps it works if a patient has a problem, comes in once and is referred and is happy to sit at home in pain/suffering patiently waiting for the appointment to be sorted. In reality they don’t. They attend multiple times, they ring 111, 999 go to A&E. Why not have specialist advice/management plans available the moment the GP feels more help is needed?
The GP can still act as a filter, in many cases the GP can sort the problem, increasingly GPs do the work that hospital consultants used to do. But once an abnormal set of blood tests come in or a simple investigation is abnormal or even with a history or examination that is abnormal why not have a virtual consultant in the room on “skype” giving advice on what tests are needed and what to do next.
Similarly, why wait for tests? I have a patient with a problem that we don’t know what it is. I’ve already used time as a diagnostic and therapeutic aid, “come back in a few weeks and if it’s not gone we will do some tests...” Once I’ve made the decision I need a test why not get it done then and there.
Ok this might not work for an operation! But I think the revolution we need is to bring the consultant into the GP surgery, the only way to do that economically is virtually.
The only way to cut the wait for diagnostics is to heavily invest in putting them as close to the patient as possible. Perhaps need to train GPs to do more themselves but I suspect there isn’t time. Perhaps I see a scanner being held by me and the images being seen remotely as well with the person at the other end telling me where to move and place the probe. I should imagine it’s much easier to teach this than how to interpret.
However, I suspect we need a massive expansion in technicians who can scan or operate XRay/CT/MRImachines. Also, do we need smaller machines? The local university has a MRI scanner that just does knees – is it better to have lots of little ones? Or perhaps push the scanner on a truck approach. Ultrasound scanners are now cheap and portable, why are they still the preserve of the hospital. Why doesn’t my 18 doctor practice looking after 25000 patients have one?
We are lucky enough to have a visiting Ultra Sound Service in our practice a couple of days a week – if you are lucky and they aren’t over busy you can sometimes talk them into doing a scan then and there. It makes a huge difference the patient leaves the building with an answer or diagnosis. How much better would it be if I could get everyone scanned immediately?
Point of Care Testing is also ripe for development. Taking venous blood sample and sending them to the lab seems so old. Capillary blood testing or finger prick with either single use kits or POCT analysers in each practice makes more sense and expands the times they can be used. It could halve the number of visits a patient makes to a surgery and improve clinical decision making by having instant results. We need to understand the cost implications as each test is more expensive but is the overall cost? I think no.
It’s time to start working differently. Bring hospital consultants into the community – using technology, get instant scans and test results to massively reduce the time to diagnosis and hopefully therefore treatment and cure. I believe the tech is out there, we just need to start changing behaviours and move the money.
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.
Link to previous article: The next wave of Healthcare Innovation will be driven by Primary Care