How can primary care escape from a spiral of decline - a future of staff burn-out and further declines in patient confidence?
In this paper Aiming for Health Success points to a different future: how expansion in the use of new technology can not only improve access, but also free up time for continuity of care. It can also open the way for immediate action on how integrated care can improve outcomes.
Greater use of e-consultations can be vital to improved patient experience and health outcomes, as well as clinician productivity and job satisfaction. It can also be a key resource for the second generation challenges of improving care for patients with long term conditions and outcomes for local populations.
In the next five years primary care will have the key leadership role in the expanding range of services closer to home. There could be a new era of local NHS services and achievement.
In 2022, Aiming for Health Success was commissioned by eConsult to produce an independent research paper on the impact of e-consultations at the practice and local health economy levels
Better routing of patients to the right member of primary care staff could free up 30 per cent of current GP appointments - equivalent to 50 million appointments a year, or the recruitment of 8,400 new GPs.
Across all providers, there are around 2.5 million e-consultations per month, equivalent to around 10 per cent of appointments.
Large volumes of indistinguishable e-consultations have posed challenges for practices. To help with this, the eConsult management team is developing the use of artificial intelligence to read and route e-consultations within the practice team and beyond, for example to community pharmacies.
E-consultations in primary care and urgent care could become the foundation of a single integrated urgent care pathway, as recommended in the Fuller Stocktake. Integrated Care Systems should consider buying integrated solutions that cover primary care, outpatients and urgent care rather than separate solutions for each.
Practices can make progress within months by:
1. Integrating e-consultation within practices, urgent care and outpatients across an ICS to encourage horizontal integration (across different primary care services) and vertical integration (with urgent care, diagnostics and outpatients). Link databases and information about external referral pathways to wider services, such as pharmacy, social prescribing, physiotherapy, counselling, diagnostics, and other specialists. Use remote consultations, applied inclusively, to address a higher proportion of those with self-limiting or episodic illness, whilst also keeping other channels open for those who struggle with technology. Separate out teams to target planned care arrangements, so those patients with long term conditions (LTCs) are proactively approached to complete e-consultations that identify which patients are deteriorating and should be actively targeted. Use the wider database to identify patients with high risks of serious health problems in their patch, to develop the right services for their community. Over time, develop team-based personal contact with higher risk patients. Practices or PCN hubs teams could develop systems to review LTC e-consultations weekly to identify where personal contact might be required and proactively reach out to them.
2. Reviewing practice and Primary Care Network populations. Identify disease / disability / risk patterns. Develop programmes for care and prevention, working with Health and Wellbeing Boards. Brief patients, local press and stakeholders on gains for local community health. Gradually get recognition as a hub for promoting better health and reduced disability. GPs become key champions for better local health and wellbeing. Primary care becomes a “someone, somewhere” rather than an “anyone, anywhere” service.
3. Developing multi-disciplinary micro-teams to provide relational continuity to those with greater health needs e.g., for patients with longer term conditions such as respiratory, cardiac, diabetes and mental illness. Combine high level national and locality-based outcome measures. Champion those which consistently give patients a good service whilst using health professional time effectively to improve outcomes.
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