To improve patient outcomes, primary care must evolve
Dr Andrew Whiteley examines what tech-assisted primary care could look like in the near future and what this means for GPs.
Most of us remember the ‘good old days’ of primary care. I look back fondly on my time as a GP – admittedly, through an occasional rose-tinted lens. The role used to mean being a family doctor 24 hours a day and involved building relationships with patients as you’d continuously see the same faces. We would listen to our patients’ concerns, offer reassurance, and provide access to treatment in a timely manner. Rose-tinted glasses or not, most GPs could be relied on when help was needed.
However, Covid marked the end of ‘normal’ service and, since then, increased workloads have meant less time to assess new ways of working. While we could debate the reasons for this, we’d be better off shifting our focus to the current landscape and the opportunities it presents for improving the patient experience and the health of the population. Opportunities which, I’d argue, will be driven largely by technology.
In my view, the population’s medical requirements can be split roughly into three groups.
Group 1: The worried well
The worried well are people with mostly minor issues who are looking for reassurance. They make up around a third of patients seeking GP appointments. Thanks to technology, this is set to change in the next few years.
Through the use of wearable technology like smart watches, as well as devices we use at home such as smart scales, thermometers, blood pressure machines, oxygen saturation monitors and more, technology provides the capability to track, store and monitor our health data in the cloud. As such, there will no longer be a need to schedule an appointment, unless a change in pattern is noted.
Should patients require professional help, they’ll be able to virtually consult with a different practitioner every time without it affecting outcomes or decision-making as each professional will have access to all their health records.
We are currently on the fast-track to this scenario. Technology exists that can detect respiratory rate, pulse, blood pressure and oxygen saturation using a traditional digital camera. Once this is migrated to other devices like laptops and PCs, and integrated with other technologies, even smart home devices like Alexa will soon be able to check on our health patterns and offer related advice.
There are, of course, potential barriers – some may argue that technology can intensify health anxiety and subsequently increase the demand for services. My belief is that technology and AI has an important role to play in patient health. By capturing patient data in one place and monitoring trends, potential problems can be identified long before traditional healthcare would be able to. This will enable clinicians to act sooner, meaning that patient outcomes can be improved.
Group 2: Patients requiring mental health support
It may be a controversial view, but considering that GPs don’t know their patients as well as they once did – not seeing the same practitioner every time means there is a lack of knowledge of a patient’s background, family relationships, etc. – primary care may no longer be the best fit for patients requiring mental health support.
It makes more sense for this service to shift to hospitals, where consultant-led mental health teams can assess patients and provide access to the required services, including acute mental health professionals, community psychiatric nurses, talking therapies, counselling and more.
Group 3: The chronically ill
The final third are patients with chronic conditions. Although I initially thought that the management of chronic conditions should remain under a GPs remit, an initiative at the John Radcliffe Hospital in Oxford has changed my mind.
They have started a nurse-run service where patients are provided with smart scales linked to an app. They weigh themselves twice a day and when their weight begins to increase, a nurse is alerted and visits them to take blood and check their urine. If required, and following a two-minute conversation with a consultant, their medication can be adjusted.
Why is this a game-changer? Because they previously had four or five people admitted with heart failure every day. Since starting the initiative, they have one per month. It’s a great example of how technology can keep people healthier with minimal intervention – it does the work and the professionals step in should help be required.
A rebrand for primary care clinicians
I’m not saying that the role of GPs will become obsolete. Instead, I think they can still make a valuable contribution in more complex cases of multiple pathologies. However, this may require a ‘rebrand’ as community primary care physicians, supported by nurse-run services and backed by technology.
What this means is that while nurses can look after those with singular chronic conditions such as asthma, diabetes, heart failure, etc., patients with two or more chronic illnesses will require a higher level of care. I believe there’s an opportunity here for entrepreneurial GPs to set up services and offer their expertise more widely, much like hospitals do.
My views, of course, hinge on a few caveats.
On the clinician side, technology must ensure accurate recording and data must be available to all healthcare practitioners. This will require a commitment to gaining as much knowledge from every patient interaction and ensuring it is accurately and comprehensively recorded. This is where technology, such as Lexacom Echo, has a lot to offer.
On the patient side, the fair distribution of technology will play a crucial role. Technology must be accessible for people of all ages and backgrounds to use. While not every patient will have (or want) an Apple Watch or a smart speaker at home, the John Radcliffe initiative has proven that devices and monitors can be bought and successfully loaned to patients. This could potentially save the NHS tens of thousands of pounds in treatment costs. It could also leave patients better off – if we can get it right.
