The doctor will see you now: making the whole patient-GP relationship virtual
The UK is slowly progressing towards a situation where it may be possible for a patient’s entire relationship with primary healthcare providers, like GPs, to be virtual. From ensuring quick access to patient data, to the patient-doctor consultation and from ordering prescriptions to tracking adherence and feeding back data, a seamless virtual cycle is entirely imaginable– but how will it work in real life? Allie Nawrat finds out.
Digital access to a patient’s medical history
A central part of the NHS’ Long Term Plan is to improve data sharing and communication across the NHS. Since the NHS is made up of a range of large, separate, but closely linked organisations, sharing data is very complex and time consuming. Technology can help to accelerate and improve these processes, allowing clinicians and nurses to be able to focus on quality care.
As part of this commitment, NHS Digital introduced a new service called GP Connect across the city of Leeds in September last year. This scheme allows GP practices and clinical staff to share and view patient records digitally from anywhere and across different IT systems.
The NHS believes a system such as this will improve data sharing between primary and secondary care, facilitating better knowledge of a patient prior to consultation and easing, as well as improving, decisions about patient care.
Leeds Teaching Hospital Trust has been the centre of this pilot programme. Its chief digital and information officer Richard Corbridge said: “GP Connect connectivity improves the way data can be used as information in clinical practice throughout the city.
“Delivering integrated care for the population is the key goal for every healthcare system and why the investment in digital is so intrinsic to the success of healthcare as a system, rather than as silos of excellence.”
Due to the success of the scheme in Leeds so far and in line the NHS Long Term Plan’s pledge for the institution to work closely with technology companies, NHS Digital is seeking new partnerships to create a pilot application programming interfaces that could be rolled out further afield; GP Connect has already been rolled out in Newbury and Norwich.
Virtual consultations using video messaging
In the same way that using digital tools for data sharing means doctors can focus on care and not waste time on administrative tasks, Starleaf systems engineer Dan Boddington argues that virtual consultations can reduce the burden on health care providers, particularly out-of-hours doctors.
Boddington said: “Providing patient-centred video healthcare to communities offers enormous scope when it comes to eliminating unnecessary repeat consultations, difficulties in on-site attendance, delays in diagnosis and prescription orders.
“[Virtual consultations] can enable healthcare services to focus their already scarce resources on the patients that need them most, offering virtual consultations to those with less urgent care needs and giving a significant amount more time to those with urgent needs.”
In collaboration with the University of Oxford and Microsoft, the NHS is currently scaling up a project initiated at the Barts Health NHS Trust in East London where video consultations are part of the outpatient strategy.
In 2017, the charity Health Foundation awarded the project £471,000 to create a virtual consultation unit at the East London hospital to support other hospitals in rolling out virtual consultations through workshops, resources and an online forum. Currently, two external sites are being set up at the Oxford University Hospitals NHS Foundation Trust and Northumbria Health NHS Foundation Trust. It is hoped that this project, which concludes in 2020, will act as real world evidence of research conducted into the advantages of virtual consultations and lead to a change in national policy.
University of Oxford Nuffield Department of Primary Care Health Sciences, which will evaluate the project academically, professor Trish Greenhalgh said: “Remote video consultations are becoming increasingly more acceptable to support, and sometimes replace, face-to-face or telephone consultations.
“By setting up and evaluating a virtual consultation unit in an NHS setting with our clinical partners, we hope to learn more about how to overcome the logistical and regulatory challenges associated with their use. This will provide a balanced assessment of when, how and in what circumstances this model might be introduced in other healthcare settings.”
Ordering prescriptions to your door
In 2013, the NHS implemented the electronic prescription service (EPS) in selected parts of the country. It allows doctors to send prescriptions electronically to the pharmacy, rather than patients having to pick up repeat prescriptions from the doctor’s surgery.
NHS Digital describes the benefits of the EPS as reducing the administration burden on doctors and pharmacists, less paper is being wasted and patients collecting repeat prescriptions without needing to go to the GP or worrying about losing the paper prescription.
The service’s nationwide scope has been steadily increased over the past six years. In November 2018, the EPS entered phase four of its implementation in eight clinics, with four added in December and eleven added in January 2019. Phase four linked EPS with a token to be scanned at the pharmacy, allowing the prescription to be downloaded from a centralised database.
In February this year, following a successful pilot scheme initiated in October, the EPS was expanded to allow pharmacies to dispense schedule two and three controlled drugs, meaning even fewer patients will rely on paper prescriptions.
The continued roll-out of EPS is a huge step in digitising a crucial area of medicine that was wasteful of doctor’s time and resources, as well as paper, however, the digitisation of prescriptions has progressed further; patients can now order repeat NHS prescriptions directly to their homes through apps like Pharmacy2U.
Pharmacy2U integrates the entire prescription process into one platform; patients use the app to request medication, the patient’s GP is informed and they electronically send the prescription to a Pharmacy2U pharmacy, which dispenses the medication.
Prescriptions are then delivered free of charge to patients within seven to ten days. The app can also remind patients who they need to re-order their medication.
Pharmacy2U claims its platform saves each GP practice 60 days of work a year and dispensing costs are between 16% and 29% cheaper than other methods based on the NHS statistics calculator.
Remote monitoring of medication adherence
A clinician being able to access a patient’s data and perform a virtual consultation and patients being able to have their prescriptions delivered to them is futile if patients do not actually take the medication they were prescribed. Successive reports have shown that medication non-adherence remains a barrier to successful healthcare outcomes.
The UK’s medicine pricing regulator the National Institute of Health and Care Excellence (NICE)’s guidance on drug adherence included better communication between doctors and patients so patients feel more included in decisions about their medication.
Existing methods to reduce non-adherence to medication have had limited success, leading to digital technologies being considered as an alternative.
In 2016, the NHS backed a patient management platform called Healthera created by researchers at Cambridge University’s Institute of Public Health. Healthera uses push notifications to remind patients to take their prescribed medications and to reorder them once they are running low, an action which can be completed through the app itself. The app also contains instructions about how to maximise wellness from the medication provided by clinicians.
After the company was awarded seed funding from Cambridge Enterprise, Quintus Liu, chairman and CEO of Healthera, said: “The NHS needs a transformative solution to medical non-adherence that can be easily scaled to its entire population. That’s exactly what Healthera provides.”
The Healthera platform feeds any patient data about adherence to healthcare providers in real time. Due to improved integration through digital platforms like GP Connect all care providers will have greater knowledge of how a patient uses their medication, helping to improve and personalise quality of care for patients.
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