It is now widely accepted that general practice is in the midst of a workload and workforce crisis. Doctors, politicians and academics alike have been weighing in with competing visions on investment, recruitment and new models of care.
But for Dr Shahid Ali, a Bradford GP and professor of digital health at the University of Salford, the answer is simple: the future of general practice lies in digital health.
‘The use of digital health technology has been phenomenally beneficial for us and our patients,’ he says.
Dr Ali says that the current system is too ‘reactive’, and that a proactive approach is needed to reduce workload.
Shared goals for patients and GPs
Dr Ali has developed an online application through his digital technology company, Dynamic Health Systems, that allows patients to set goals with their GP such as monitoring BP or blood sugar levels. It then lets GPs view patient records to track their progress.
‘If patients are hypertensive or diabetic, you can see if it’s being controlled, and look at the results of their tests,’ he says.
Around one thousand patients now use the service - called VitruCare - and the number is set to rise as Bradford, Cumbria and North Yorkshire CCGs have now commissioned the service in their practices.
The program helps doctors share decision-making with their patients, which might help to explain the 80% success rate in patients achieving their mutually set goals, Dr Ali says.
‘The patients love it, and it’s made a complete difference to their health,’ he adds. ‘It’s an opportunity for people to maintain wellness and prevent disease.’
Dr Ali refers to the service as ‘managing patients by exception’, with healthy people taking steps to control their conditions and GPs diverting time and resources to seeing those who need more hands-on care.
Technology can save practices the equivalent of a year's work for one GP."
Practices could reap huge benefits from this approach, he believes.
‘We’ve calculated that if a practice works like this for all of its patients, it can effectively save all the work that one GP does in a year. They’re managing the demand more effectively,’ he says.
Dr Ali and his team have also helped to develop an e-consultation scheme, allowing him to contact consultants from Bradford Royal Infirmary and get a secondary care opinion within 24-48 hours.
‘We can get an opinion much more rapidly, from the consultant that advises you on how to manage this patient in the community, or who says we need to see them in outpatients.’
The service has reduced the need for hospital appointments for chronic kidney disease by 90%, with consultants advising GPs on how best to manage patients in the community. His team is now planning to implement the service for cardiology and rheumatology.
Dr Ali says that telemedicine consultations with people in care homes have also reduced his need to travel to them by three quarters.
Telemedicine cuts GP workload
‘I’m saving quite a lot of time, as I don’t need to do the 20-minute journey there, and the journey back,’ he said. ‘It’s helping me to manage my workload, and I’m becoming more productive.’
But innovative schemes like these need better support from NHS organisations to make a real difference, Dr Ali believes.
The slow national roll-out of successful local schemes can be frustrating, Dr Ali says. ‘You have something which is innovative and evidence based, and nothing much happens with it.
‘The NHS is very slow to change, and it needs to pull its finger out. You have to take good ideas, establish them, scale them up and give them the support that’s really needed.
‘This is the future of care, and a massive opportunity to work much more productively, and manage our time intelligently. Ultimately, innovation will help us to remain sustainable in the future.’