General practice is facing two major challenges; demand and recruitment. Lots of people talk about the ageing population, but our population is exploding and its mainly younger patients with high levels of health seeking behaviour.
It’s consumer-driven demand. We are growing by almost 1,000 patients a year and 87% of our practice list came through the door last year at least once. Some people visited over 40 times - that’s almost once a week. Yet our medical workforce is reducing; GPs are retiring, going part time or moving abroad.
Federations are often held out as a solution. People mean different things by federation and not all federations have the same emphasis.
However, what most GPs seem to be interested in is banding together to generate savings and to work as efficiently as possible. I have helped to set up a federation, which covers 30 local practices. We got engagement from practices by helping them; but got funding from the CCG by also looking at service delivery.
Investing in IT
One of the things we have done is invest in IT support. My federation now employs three IT support people; and it makes a huge difference to the lives of our GPs and their staff. However, it’s also helped improve the services to patients by implementing projects that otherwise wouldn’t have happened.
Practices are also coping with more work moving from secondary care. But how can primary care be the solution when it’s drowning in work? We need to free up resource. Which brings us back to efficiency.
If there are four surgeries in an area, do they all need a practice secretary or a clinical coder? Could savings be put into new clinical staff? If so, can we change the skill mix?
We have advanced nurse practitioners and pharmacists, but they often need supervision or mentoring - and how do you provide this efficiently? There’s a massive role for IT here. My idea for Skype-type services is not to use them as yet another way for patients to call me, but for providing support to staff or for getting everybody together without the hassle of commuting.
What are the problems?
The problem is that technology is not solving our problems at the moment. Our commissioning support unit does not invest, and our infrastructure is falling over.
My PC crashes all the time – and I’m the IT lead. My wife, who is also a GP, emailed recently to say that it was taking eight minutes to print a prescription – in a ten-minute consultation.
Even when they are not falling over, our systems don’t do what we need them to do.
I have all sorts of technical problems accessing my GP system when I am away from my practice. And systems don’t have open application interfaces, so they can’t link into anything new that’s worth having without a huge amount of cost and trouble.
So, how do we move forward? First, we need to get out of the current mess, and then we need to find a way of getting good ideas from innovation to product to deployment faster. That means we need to get partnership back into the market.
One of my patients is the head of IT for a large engineering firm. He has a huge IT budget, and if somebody in the company has a good idea, they can develop it, test it in their own testing environment, and roll it out.
We can’t do that. As a federation, we managed to build a sharing platform so people can pose questions and have them answered by other users. We hired a programmer, and put it on a server, and we’ve just about managed to keep it running; but no one practice could do it, and as a federation it wasn’t easy. So, sorting things out will need scale, and it will need funding, and it will take putting GPs back in charge of that funding.
Back in the PCG days, every practice had an IT budget that they could spend or top-up, and most people topped up. You could argue that it was not very efficient to have a lot of practices going out and buying printers, which is why the budgets were pooled and given to CCGs and CSUs. But GPs stopped thinking about IT, because it was supposedly being done by professionals.
Hospitals have made a big investment in chief clinical information officers and we need something similar for primary care. We need people who are excited by IT and know how to make it work for them.
People often say that primary care is ahead of hospitals when it comes to IT; but I think hospitals are now starting to look very sorted.
The IT lead at my local hospital has a decent budget, a good team, and she can get the big companies in. If we are not careful, hospitals will accelerate past general practice when it comes to IT. We need to find a way to get back in the game, because we do need that technology to help us manage the pressures we are under.
- Dr Paul is a GP in Sandbach, Cheshire. He will be speaking on IT in primary care at EHI Live a two-day conference and exhibition that takes place in Birmingham from 31 October to 1 November.