Digital First – a Patient Perspective

A couple of years ago I wrote a somewhat tongue-in-cheek article about how much the NHS could save each year by implementing some fairly basic mHealth initiatives.  Nothing very complicated – mostly simple stuff like appointment reminders, but with the help of some silly projections from NESTA I reckoned there was potential to save almost £13 billion a year from the NHS budget. 

A few weeks ago I came across a much more sensible proposal in the form of Transform’s Digital First report for the NHS.  Whilst my effort was largely based on fanciful numbers from corporate PR departments and think tanks trying to get noticed, the Digital First report uses real examples of current practice within different parts of the NHS.  It looks at ten easy-win initiatives which, if they were to be implemented across the wider NHS, could release funding of £2.9 billion per year. 

These are not high tech; they don’t require massive capital investment, they’re just ten good ideas which have been developed and deployed locally and which can be copied throughout the country.  Most are centred on GP practice.  In each case, the report describes the current implementation, the degree of difficulty (or in many cases the ease) of attempting each project, and details of how to do it.  There’s even a Digital First website “designed to help NHS staff implement Digital First”.  The report is essentially an instruction manual for every GP surgery.  I’d recommend downloading and reading it.  And the next time you see your GP, give them a copy or ask them how they’re getting on with it.

The most refreshing thing about the report is that it makes it clear that digital should be an expected part of the patient experience.  As it notes in the executive summary, “no-one working today in the NHS should feel that healthcare is so significantly different from other areas of contemporary lifestyle that it is immune from benefitting from digital”.  Today the patient experience of the NHS is lagging far behind almost everything else that we do in our daily lives.  There are not many companies or services today that we can’t contact via email or the web.  Except the NHS.  Granted, there are exceptions, and the point of this report is to highlight those that have seen the light and promote them as exemplars.  It’s not a grand digital strategy they’re putting forward – it’s far more practical.  It’s all about taking examples of good innovation and replicating them.

Again, quoting the report, “Digital First is about making available the digital means for the general public to manage their healthcare digitally wherever possible and provide the mechanisms and support to ensure they can migrate to these digital channels as their preferred manner to engage with their health at all but the most necessary levels”.  Yes please.  And the sooner that happens, the better.

The report doesn’t make any recommendations about which of the ten projects to address first – it is instead a broad call to action.  I’d like to take the opportunity to restate the ten initiatives, but ranked from a patient’s point of view.  It’s a personal viewpoint, as they’re all valuable things that would make a real difference to the way I interact with the NHS.  And they are all things which should be done now.  But to reinforce the value of this report to all of us who use the NHS, here’s my perspective.

1.      Appointment Booking Online – cost efficiency £53 million

I don’t think my GP surgery has changed its booking procedure in the 30 odd years I’ve been registered with them.  It feels as if they’ve just let the surgery list expand whilst keeping the same number of phone lines.  As a result I normally have to try calling at least half a dozen times to get through.  In an age when I can book a specific seat on a flight or in a theatre, book a meal, a car, a holiday or a supermarket delivery online, why do I still have to hang on the end of a phone to book a routine appointment?  Please – make them go online.

2.      Remote Communication of Test results – cost efficiency £1.12 billion

I found it difficult to believe that the NHS runs 50 million appointments a year to tell patients that their tests are negative.  If they used text messages to inform patients of negative test results, rather than getting them to visit their GP it would save £1.12 billion.  It frustrates me that after any tests I have I’m called back to see the consultant or GP just to be informed there’s no problem.  If a test is negative, you can just tell me, rather than forcing me through the archaic appointment booking process and then asking me to take a half a day off work.  This seems so obvious, it’s criminal that it’s not already done.

3.      Secondary Care Patient Letters – cost efficiency £94 million

It’s not only conveying information to patients that wastes money; it’s internal communications as well.  This is at number three in my list because it’s a bit of a personal gripe.  Every time I see a GP or consultant in the NHS I tend to get wound up by their single finger typing and the Dictaphones.  I’m not aware of any other profession where this level of a) lack of technical skills and b) acceptance that there will be a secretary to type it up is still acceptable.  The fact that these notes are typed up, stuck into envelopes, have stamps stuck on the envelopes and are posted to another person within the NHS rather than being emailed is amazing.  This is £94 million spent just for internal letters.  It’s time to catch up with technology.

4.      Remote Follow-up in Secondary Care – cost efficiency £326 million

Back to my second point – why do I need to have to keep making physical appointments when a phone call or email will do just as well?   This plays to the old view that the system is designed for the benefit of the medical professional, preferably in the mould of a Sir Lancelot Spratt, who feels they need to be seen to be appreciated.  Not by most of us.  We’d appreciate them more if they saved our time and money by using the phone or email. 

5.      Post-surgical remote follow-up – cost efficiency £41 million

And the same type of efficiency again, this time for post-surgical follow-ups.

6.      Primary Care Pre-Assessment – cost efficiency £903 million

This may feel like a recurring theme, but I do think that for much of the time, my GP can be just as effective at being a doctor if they’re at the end of a phone or a Skype video call.  The Digital First report doesn’t attempt to assess the cost to patients of taking time off work to travel to appointments, but I suspect it massively exceeds the £3 billion cost efficiencies that it calculates for the NHS.  The current working practices it aims to change all have a significant impact on patients, wasting them time and money.  That makes it doubly important to move ahead with these recommendations.

7.      Pre-operative Screening Online – cost efficiency £34 million

This is low on my list, simply because it’s not a resource I’ve ever used.  I’m in the lucky position that the only operation I’ve had is to remove my wisdom teeth.  But I can appreciate the benefit that this would bring.  And I hope it’s in place by the time I need it.

8.      Mobile Enabled Community Nursing – cost efficiency £36 million

Again, a resource I’ve not had to call on yet, so probably lower in the list than it deserves.  However, there’s a growing amount of evidence that community nursing is a very receptive area for digital, with community nurses quicker to embrace mobile technology than GPs.  So with luck it will happen anyway.

9.      Minor Ailments Online Assessment – cost efficiency £154 million

I’d probably put this higher, other than for the fact that there’s already a lot out there on the web, so from a patient perspective it’s not as big a hole in my overall NHS experience as things like online booking.  But the NHS has the scale to make online tools like this really effective, so please don’t stop developing them.  It’s a resource that has value beyond the UK, providing the opportunity for the NHS to become the pre-eminent global healthcare provider. 

10.    Appointment Reminders – cost efficiency £264 million       

This is the only thing my local hospital and dentist does from this list of ten easy wins (although my GP doesn’t).  So I’ve put it at the bottom of the list.  But it really should be standard practice, particularly if it can reduce the 5.9 million missed appointments every year.

So that’s my personal view as an NHS user.  There are none of these I don’t want and I suspect most members of the population would support me in that. 

It’s interesting that the report calculates a value for “cost efficiency” rather than calling it a saving, although the text does keep dropping into the more honest vernacular.  Whilst these initiatives would make more effective use of time and resources within the NHS, they only save money if you physically get rid of staff to save the salary costs.  When I wrote my previous article I had a number of responses from GPs and Consultants claiming that these could not be classed as savings.  Their argument was that the missed appointments were “necessary” as they gave them time to catch up on their paperwork.  Their view was that if all of their patients showed up, they’d have to reduce the number of patients they saw in order to fit in their administration tasks.  I’ve not got a lot of sympathy for that view, as it feels like an attempt to hang on to outmoded working practices, but it highlights the fact that alongside these projects we need to work in parallel to change some more deep seated attitudes if we’re going to gain the full benefit.

But that does not detract from the aims of Digital First.  It’s an NHS initiative that I fully support as a patient and taxpayer.  And it feels all the better because it appears to be driven by commonsense and pragmatism rather than politics.  So join me in applauding the initiative and in asking your GP to put a plan together to implement these recommendations.  They’re about to enter a brave new world of commissioning, so they should welcome these projects as a useful starting exercise in that learning process.