NHS of the future: The technology that could replace your GP

Talking to technologyTalking to technology
Talking to technology
As part of a detailed look at proposals to shake up the NHS to try and make major financial savings, the Johnston Press Investigations Unit looks at plans to increase technology use.

Forget “Physician Heal Thyself”, plans to shake up health services and save the NHS millions seem to hinge on patients either not getting ill in the first place or looking after themselves with an increased use of technology.

However, campaigners are warning of the dangers of the tech revolution and say patients will suffer if health bosses try to replace them with apps.

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A leading GP believes the health service is gambling millions on plans to use apps, Big Brother-style monitoring devices and video-link surgeries to bridge a five-year funding gap.

Health bosses around the UK are drawing up plans to shake up the patient-doctor relationship by limiting “face-to-face” interactions, both in the NHS and in drastically under-funded council-run social care.

Johnston Press Investigations found all 44 Sustainability Transformation Plans (STP), produced by regional NHS bodies, plan to meet strict five-year savings targets by increasing the use of new digital technologies to deliver health services.

Proposals include increasing “virtual appointments” where patients can talk to their GP, or take part in a group therapy session via video-call.

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“Artificial intelligence” apps are already starting to deliver diagnoses on the private market and are already being discussed by Clinical Commissioning Groups (CCGs) looking to assess patients without the need for a face-to-face meeting.

But leading GPs are not convinced the move is the magic formula in helping the NHS meet its £22 billion shortfall.

Helen Stokes-Lampard, chairman of the Royal College of GPs, believes video-link doctors’ appointments could actually increase their workloads.

She said: “While these might be convenient, they don’t actually reduce a GP’s workload as a 10-minute patient consultation takes 10 minutes whether face-to face-or over the phone - and in some cases virtual consultations can increase workload, if a follow up face-to-face consultation is necessary.

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“Whatever happens, the GP-patient relationship is unique in medicine and there is no app, algorithm or technological innovation that can, or will, replace it in the foreseeable future.”

All 44 STPs are seeking to drastically reduce accident and emergency admissions, scheduled visits and “face-to-face” care in part, by moving towards a model of what has been labelled “self care.”

Chris Moulton, vice-president at the Royal College of Emergency Medicine, believes types of preventive treatment are “absolutely the morally and medically correct thing to do.”

But he warned they should not be used as a way of saving the NHS money.

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He said: “When a 60-year-old person takes statins and other drugs to avoid having a heart attack, they don’t sign a pledge saying that they will never use the health service again for the next two decades.

“Using lifestyle changes and medical interventions to prolong happy lives is the right thing to do. But it is not the answer to the financial crisis facing the NHS.”

In adult social care the STPs talk of plans to increase “telecare,” where elderly or disabled people can be monitored by devices in their own home.

One union leader fears the plan, which campaigners fear is a move for cash-strapped councils to reduce home visits, is flawed.

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Guy Collis, health policy officer at Unison, said new technology would require staff to undergo extensive, costly raining, before it is rolled out.

He said: “I think too often there’s this idea that they can be a quick shortcut for savings or improving patient experiences,

“That’s all well and good as long as you have the right people. The NHS doesn’t have a great track record for IT.”

However, Madeleine Starr, director of innovation at national charity Carers UK, says the move to self-administered healthcare is “inevitable” considering the huge deficit in the NHS.

Patients, she believes, will simply need to adjust.

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She said: “We need to move away from the idea that a GP is a sacred cow you’ve got to sit in front of.”

‘Not a replacement for care’


“I think there is some good work going on with making use of technology so I would not dismiss digital healthcare as out of hand.

“It will help people who are housebound and is quite a clever way to remotely monitor someone’s symptoms or have a video consultation.

“That definitely has merits.

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“But I think it should be an additional thing and it needs to be a decision doctors and nurses need to make on which patients are suitable for this.

“There are some patients it won’t be suitable for. The issue doctors face at the moment is not having time as things are so pressurised, they are dashing from one patient to the next.

“Technology should be a additional thing, not a replacement for care.”

‘A computer can’t hold your hand in a crisis’


“The most important thing to realise is that technology on its own is never going to replace a doctor or a nurse.”

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Declan Hadley, digital health lead for Lancashire and Cumbria change programme, said: “In times of crisis, you are always going to need to see someone. A computer can’t hold your hand.

“But in almost every area of our lives, we use technology in different ways such as banking and shopping but we have not really grasped it when it comes to accessing healthcare.”

Some of the ways of using technology in healthcare being trialled or used across Lancashire and South Cumbria include a person record exchange system where records of care move around with the patient and are accessible to the people providing care to them. Part of this involves patients accessing and contributing to their records.

One of the other things being pushed is apps to get patients more involved in their own care.

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Declan said: “We are aiming to create super apps which will be integrated into their health records. We have just done the first one which is aimed at people with Chronic Obstructive Pulmonary Disorder.

“The apps will be prescribed as part of their healthcare.”

Bosses are also looking at how digital means and technology can be used to support people to stay in their own homes.

Declan said: “We have got the ‘test bed’ in Lancashire and are looking at technology which can monitor things like if someone falls over in their home.

“This technology is a partnership between Lancaster University and a number of other health organisations and is looking to support frail and elderly people in their own homes.

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“As well as monitoring for falls, this technology allows patient to check their blood pressure and weight themselves in their own homes.

“This doesn’t mean they won’t still see health professionals when they need to. It means people who might have gone into a care home can stay in their own home for longer.”

Other technology being looked into and trialled is allowing patients to have Skype consultations with their clinician from the comfort of their home.

Declan said: “There is a whole piece of work going on to extend the ability to use Skype and Facetime.

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“Within the next 12 months, we want to allow patients to book an appointment with their GP and do it over Skype if that’s what they want to do.

“Some of these technological innovations are unique to Lancashire. We are right at the cusp of leading the way with these digital healthcare means.”

‘Delivering care in a different way’


“There are enormous financial pressures on our services. But it isn’t all about the money, even if it may appear that way.

“The health outcomes we get from our services are among some of the poorest in the country.

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“We need to work together better across health and care and make better use of technology to make sure people receive the best possible treatments and so these outcomes are improved.

“It is about delivering care in a different way and using technology better.

“Using technology and digital health is one of our priorities to help people manage their conditions.”

‘It should be an option, not the option’


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“Prevention is always better than cure and using technology can be a good thing if it is used in the right way.

“But it should be used as a supplementary service not to replace direct patient care.

“Some older people do not always have that grasp over technology so to drive them towards that is not beneficial.

“If some people embrace the use of technolgy for health, it will allow doctors more time to deal with those who need them.

“If you are able to use that technology and want to use it, it should be there as an option, not the option.

“You can never replace that doctor and patient relationship.”

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