Digitising primary healthcare during Covid-19

Turning to technology in a crisis

Throughout the COVID-19 pandemic, we’ve seen headlines touching on subjects like virtual consultations and remote treatment. It seems that the pandemic has been a catalyst to the use of digital technology in the NHS. But the majority of these news stories have focused on primary healthcare, since a lot of the impact on ways of working has been focused there. In fact, in secondary healthcare, a lot of services did not adapt, they simply shut down to enable a greater focus on COVID-19 patients. The default remains face-to-face consultations and face-to-face follow ups. However, as the response to the pandemic has shown, in most cases there is probably no need to visit a hospital just to have a conversation with someone. The pandemic presents important opportunities to improve health systems through better connection between public health, primary care, and secondary care.

Leading from the front(line) 

For many people, primary care remained the first point of contact for the NHS during the early stages of the COVID-19 pandemic. However, the unprecedented nature of the crisis meant it wasn’t sufficiently equipped at the top level to fulfil its role in its entirety. It was, in fact, the quick thinking and creativity of many of those on the front line and other local care professionals that helped to keep treatment going. They helped to introduce telephone, email and virtual consulting, as well as enabling the vital task of triaging suspected COVID-19 and non-COVID-19 care.

While this enabled continuity of care, it also ensured those who did need in-person appointments were able to get them, as the new systems created capacity in the old ones. During this time, there were widespread – and legitimate – concerns about potential collateral damage to the health of those whose routine care had to be postponed or abandoned. Of particular concern was the need to manage the aftermath of the pandemic while also dealing with the potential explosion in the need for mental health support caused by it. This is where secondary healthcare services can learn lessons from the primary care experience, and shift to new, digital ways of working. 

A changing landscape

"COVID-19 has had a profound, immediate impact upon our health and care system. We have responded at pace, with some areas of our services being transformed more in the last three months than in the last decade. Not all of these transformations will endure (or should endure) but there are certainly changes that have been made through crisis that point the way to a more modern, responsive and flexible model of delivery services to our population. These changes should be identified, evaluated and, where appropriate, rapidly adopted across the country."

Primary care has been successful in managing to pivot rapidly and redirect patient flow. Things like pop-up clinics, video-only surgeries and online triage are being implemented as primary care services reshape. These advances follow in the wake of other successful digitisation efforts across the healthcare landscape – for example, the shift to electronic prescriptions. We’re now seeing 95% of GP prescriptions being handled digitally, with over 31 million patients making use of them.¹ Transformations like this are seismic, saving healthcare workers and patients significant amounts of time. This technology is now being adopted beyond primary care, in places like hospitals and care homes as part of NHS digital transformation. 

Alongside many other sectors and industries, healthcare has seen its fair share of switching to remote working. However, healthcare is facing unique challenges when it comes to sharing information such as patient records. Doing this with physical records is costly and time consuming, and creates issues around confidentiality and staff monitoring. This is where secure digital technology comes into its own with a paperless healthcare system. It isn’t just patient care that can benefit from this technological shift. Staff training and onboarding can be done online, protecting resources and reducing the need for travel. We may see the long-term adoption of online conferences too.

We have the technology…

The technology to do all of this digitally does already exist. What’s more, it can be easily integrated into current workflows so that it does not require additional resource or significant new staff investments. The onus now is on boards and trusts to update their IT strategies and invest in new frameworks that are fit for the future of healthcare provision.  

As a core tenet of healthcare, patient confidentiality is paramount in the switch to digital. IT departments will already be well aware of the security measures that need to be implemented. Many, if not all, modern devices like printers and scanners will have built-in security features such as pull printing, encryption and user authentication. The key will be providing training so that all staff members understand digitisation and can shift their thinking and habits away from the ‘traditional’ way of doing things.

The way different trusts and regions work together is also beginning to change. In primary care, there is a movement away from the more ‘siloed’ approach to enable greater collaboration. For example, the Royal College of General Practitioners’ Research and Surveillance Centre at Oxford University is urging practices across the country to come together and share information. It is recruiting 4,000 GP surgeries to contribute patient data on respiratory infections, flu-like illness and suspected and confirmed COVID-19 cases.² There are benefits to this that go beyond the mapping of disease data. Studies such as this help to open new lines of communication, where different practices can share strategies and ideas, in order to improve outcomes on a nationwide basis.

So, what can secondary healthcare learn from this?

The advances made in primary healthcare under such trying circumstances are nothing short of incredible. Despite being the frontline and first port of call during the crisis, it has managed to implement widespread advances in systems and staff behaviour. There is now a chance for those in secondary healthcare to learn from this and implement change of their own, with the following in mind:

Things can happen quickly

It’s fair to say that the NHS hasn’t always been renowned for its flexibility. Change can happen slowly. But one thing the response to COVID-19 has shown is that it is possible for the healthcare system to react quickly and implement new ways of working. This is, in part, thanks to the quick thinking of practices at the local level. They were able to use what autonomy they had to implement new processes and start new services that kept care moving. This is something secondary healthcare can use as a blueprint moving forwards. While some things will always require approval at a high level, the ability for trusts or individual locations to create their own change is there. This will be especially important as we move into more localised ‘Tier’ restrictions, where different areas are able to have different level of contact with patients.

Everyone needs to be on board 

As many IT departments will know, there can be a wide range of computer literacy amongst secondary healthcare staff. While most will know their way around a computer, some will not have experience with videoconferencing software, or may not be confident enough to show colleagues and patients how to use it. Rapid, wholesale change can be overwhelming. A strong, thorough training programme is needed to get everyone up to speed on the digitisation process. This is especially true when it comes to security – those who are used to handling paper documents securely will need to be capable with digital security measures too.

It’s important to find the right balance

Research we carried out alongside the National Health Executive found that the majority of respondents (58%) agreed that there are benefits to the new ways of working, and 53% agreed that these new digital processes were more sustainable. However, it is important to note the right balance needs to be struck. While online consultations are popular, some staff we spoke to were worried what impact this might have on older or more vulnerable patients, who are less likely to be technology literate. Location is a factor; many rural areas do not have the broadband infrastructure required to run these services. There are also some secondary healthcare situations where consultations or treatment simply have to be done face to face. Students and trainees too, may need a more hands-on approach than can be offered via online learning. A hybrid approach, where those who require face-to-face interaction can access it as easily as online services, is probably the best way forward.

Working together works better

A key thing to learn from the primary care response is the beneficial impact of collaboration. This seems an obvious point, but the healthcare sector hasn’t always been the best at sharing knowledge and data between different teams. As long as it is done securely (and with patients’ consent), sharing data can help organisations plan their response to difficult situations like COVID-19. The new methods of online interaction can also open up new lanes of communication. For instance, in the future, could a patient, GP and specialist all be together on the same video call?

Conclusion: a chance to shape the future of secondary healthcare

A lot of change has happened in a short time, and it’s fair to say that technology has been a key driver in this. Some changes may only be temporary – short-term workarounds that have allowed staff to continue functioning in difficult circumstances. Some, though, could be here to stay. There is now a chance to study what we have learned from this crisis and shape how the NHS responds to the next one. With the right technology in place, and the right partners on hand to implement it, this move to digitisation can help deliver long-term positive outcomes for staff and patients across the healthcare sector.

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^References

^{1. Dr Shaun O’Hanlon: ‘How data and digital services can fight COVID-19’}

^{2. Emma Bower: ‘4,000 GP practices asked to join COVID-19 research project’}