The NHS Digital Conundrum
Published Wednesday 19th April, 2017
It seems hardly a day passes without a reference to the NHS crisis, be it budget issues, service issues all impacting on the nitty gritty of what the NHS is actually about – providing excellent patient care. But with the Government triggering Article 50 last month, another spotlight has been cast in the area of the availability of skilled professionals to operate healthcare services. We are now wading through the reality of the major staffing problem facing the NHS. So what can be done and where does the role of technology play a part?
To provide some background to GP numbers, in 2015, Jeremy Hunt said the plan was to increase GP numbers by 5,000 before 2020. So what’s happened in the last few years to indicate that these goals don’t look very achievable?
First, more General Medical Practitioners (GMPs) are leaving than joining the NHS. There were 49,162 GMPs in the UK in September 2015. Since then, new NHS Digital statistics based on the workforce minimum data set, between April 2015 and March 2016, showed that 832 GMP contract holders joined the NHS, compared to 1,342 who left. That’s510 net leavers, thus the need to increase the number by at least 5,510 to reach the 2020 target have rendered the challenge even greater. Add to this an increase in part-time working in new GP practices and an ageing demographic of GPs indicates further significant challenges to the 2015 plan.
Furthermore, Brexit will likely impact the shortage in staffing. Figures show that 57,000 of the NHS’s 1.2 million workforce are EU nationals, and the Institute of Public Policy Research (IPPR) believes the health service would collapse without them.
Are there practical steps that can realistically be taken to alleviate this situation? In our opinion, technology can help to deliver positive patient outcomes whilst driving efficiencies. This isn’t about taking people’s jobs, but instead transforming roles and free up skilled staff to enhance patient care.
We believe there are four ways technology can support institutions like the NHS, including:
- Empowering patients to self-help rather than contact a NHS service. Technology can help to reduce the number of patients who need to see a GP, for example. Our Odyssey solution has been helping the NHS assess patients safely for many years. Now, it is allowing patients to assess themselves prior to calling the 111 service. Around 13 million people ring 111 in one year – based on early trials, indications are that around 25% of callers are safely directed to self-care, avoiding a call to 111.
- Streamline and expedite GP consultations. There are technology-based Clinical Decision Support solutions already in place today to support the consultation process. Our research has shown that patients completing an assessment before seeing a GP will reduce the consultation time by 130 seconds. In a 10-minute appointment, this is over a 20% time saving. Assuming this only applies to half of the patients seen by a GP, with a headcount across the UK of almost 50,000, one could argue that this alone could be equivalent to an extra 5000 GPs. Considering the average pay for a GP, if 5000 new GPs do not need to be recruited, this system could also save the NHS £1.5 billion.
- Upskilling staff to take on some of the work being done by more experienced staff. Using IT with proper Clinical Decision Support can allow the upskilling of practice nurses for example to extend their remit in areas such as initial assessments, to ensure this skills transfer is managed in an effective and safe way. East Midlands Ambulance Service is a great example. Using our Odyssey solution – a Clinical Decision Support software which guides clinicians using Artificial Intelligence (AI) in providing the right treatment - it has addressed problems by streamlining consultations. For example, 16% of the daily emergency calls are now able to be appropriately managed over the phone and reducing unnecessary ambulance journeys – this saves 320 ambulance journeys each day. More details on how EMAS uses the technology can be found here.
- Improving mobilisation. Getting patients out of hospital and into the community, with the right level of community care with access to medical records at point of care, will immediately ease pressure on hospitals. Simple steps such as supporting care staff with mobile devices that provide data entry at point of care can make an incredible impact on time spent on care – for example, mobile technology can reduce admin, giving back carers nearly one hour per shift to spend with residents.
What needs to happen to make this possible?
NHS England announced last month that seven NHS Foundation Trusts (FT) have successfully secured funding to become Global Digital Exemplars (GDEs) for Mental Health.
The winning bids (three of which were jointly developed with Advanced) incorporate technology developments in areas such as secure mobile access and the Internet of Things (IoT). However, given the industry is already a year into the Five Year Forward View for Mental Health, announced in February 2016, there is a need for urgency to ensure the innovations can be delivered and make an impact, without delay. The GDE project could work well, so long as the Government lives up to its promise and makes the funds available immediately – see more here.
Funding projects like the GDEs will provide a framework from which to effectively evaluate how technology can deliver a positive outcome – creating a future NHS blueprint for other institutions to benefit and take inspiration from. The biggest challenge with IT is that the investment needs to be front loaded to achieve the promised savings. Forward-thinking funding is therefore critical for putting in place the right technology foundations. Given there’s no spare cash in the NHS’s existing budget, surely there’s a need for a call to action to review how the digital transformation of the NHS can be funded to deliver the much needed long-term savings – only from this position can we hope to build a sustainable NHS fit for the future.
Nick Wilson, MD – Public Sector, Health and Care - at Advanced, with contributions from Dr. Alex Yeates, Medical Director at Advanced, and Professor Jeremy Dale, Director of Clinical Knowledge Unit, Advanced