Why digital doctors are crucial for the future of primary care
Our primary care system is weathering a storm on several fronts. Demand is skyrocketing, with GPs delivering millions more appointments than in previous years and workload far outstripping pre-Covid-19 levels. Dr Dan Bunstone explores how innovation can help GPs overcome the current capacity squeeze in primary care and tackle patient backlog.
Despite the misconception that general practice has been ‘closed’ during the pandemic, practice staff are supporting a growing number of patients whose lives have been put on hold by delays to care elsewhere in the NHS. This is all while delivering day-to-day care and the vaccination programme as we race against Covid-19’s third wave. Add in chronic staffing challenges across the health service and we are seeing an exceptionally stretched workforce, widespread burnout and many even considering early retirement.
Technology solutions like a digital workforce of clinicians are key to addressing the urgent capacity crisis in primary care. As people were encouraged to stay home to reduce the spread of the virus, clinicians quickly pivoted to carry out more of their patient interactions via video, with the shift of the last 18 months set to continue. Now, digital doctors are becoming an increasingly important part of the primary care mix. Able to deliver care from anywhere in the UK, they are helping to ease workload pressures, tackle appointment backlog, and provide patients with greater flexibility in how they access healthcare, all without the hassle of recruitment for primary care networks (PCNs) and surgeries.
A powerful addition to face-to-face care
In my experience as a GP, video consultations bring you as close as possible to patients without being face-to-face. Digital enablement via video has allowed us to look into the eyes of a patient and see their stresses and strains, just as we would in person, with a stronger human connection and better engagement than a traditional telephone appointment.
More broadly, digital solutions can help physical primary care staff better manage demands on their time by providing thousands of additional NHS appointments with clinicians who consult via video. This allows general practitioners to focus on delivering face-to-face care to patients that really need it, while also pressing ahead with the vaccination programme. Crucially, the cost of these digital appointments is significantly lower for the NHS, with savings of as much as 33% on the cost of a face-to-face appointment.
Getting patients the right care at the right time
Primary care’s current predicament is partly down to the fact that GPs are still the first port of call for any non-emergency medical issue. As a result, clinicians such as pharmacists are underused. It is estimated that one-third of GP appointments could be completed by pharmacists who are trained to treat minor ailments such as coughs, colds, aches and pains. Despite this, patients often still choose to book and wait to see a GP.
Digital solutions can help embed better triage capability into the primary care ecosystem, ensuring that patients are directed to the most appropriate clinician in the first instance. This moves us away from a system in which general practice is the default entry point into so many other services, towards a model in which GPs are just one part of a wider primary care team. Alongside triage, digital providers are increasingly able to offer consultations with a broader range of clinicians - including pharmacists, physiotherapists and mental health practitioners - within their platforms, so patients can access these appointments directly through their smartphone or device without having to see a GP first. This helps reduce an unnecessary GP bottleneck and allows patients to see the clinician who is best placed to help them recover.
To illustrate this in practice, Push Doctor’s partnership with Warrington Innovation Network boosted the number of first contact physiotherapists available to the local community. By offering remote consultations through the Push Doctor platform, the PCN can now offer the equivalent capacity of two full-time physiotherapists, leading to 210 physio appointments per week. 90% of the patients who attended these appointments were managed within the service without the need for onward referral and only 2% required follow up with a GP. This shows just how effective remote appointments can be in helping to manage GP workload.
Widening patient access with flexible staffing solutions
Staff recruitment and retention challenges across the country are also well-documented, particularly for clinicians like clinical pharmacists. NHS England has aimed to plug this gap through the Additional Roles Reimbursement Scheme (ARRS), which provides funding for PCNs to hire more staff in areas of need. But while PCNs' patient-facing workforce is rising, there are calls for greater flexibility in how PCNs can use the funding to best serve practices and local communities. For example, some surgeries simply do not have the physical space at their practice to accommodate the clinicians they vitally need.
A digital medical workforce can help solve this problem by enabling clinicians from across the country to consult remotely with patients via video call, significantly increasing the pool of medical professionals available to a local surgery, without taking up physical space. On platforms like Push Doctor, these clinicians are fully funded through the ARRS, which makes crucial funding more accessible for PCNs and provides a flexible solution to the challenges of recruiting, training and supervising these specialist roles. Providing ARRS-funded roles digitally also means that GP practices anywhere in the country can hire a named clinician without the struggles of local recruitment and retention. This will help to even out access to healthcare across the UK and reduce health inequalities due to unequal distribution of staff.
There is no silver bullet or single solution that will ‘fix’ the primary care system. But when it comes to the dual challenge of rising patient demand and fewer staff, a digital medical workforce and triaging patients more effectively will make a huge difference. As clinicians, the pandemic has caused change and innovation on a scale we never could have predicted, teaching us important lessons in the process. What stands out for me is that digital doctors will play a crucial role in the future of primary care.
About the author
Dr Dan Bunstone is an NHS GP and chief medical officer at Push Doctor.
