Interview: GPs face a digital health revolution

As the NHS embraces self-care, telehealth pioneer Dr Maurice Smith tells Stephen Robinson why GPs must remain open-minded.

Dr Smith: Soon there is going to be an explosion of apps and devices (Photo: Liverpool CCG)
Dr Smith: Soon there is going to be an explosion of apps and devices (Photo: Liverpool CCG)

The inevitable rise of affordable health-tracking technology will soon force GPs to rethink how they and their patients manage care, says Dr Maurice Smith.

'Over the next two to three years there is going to be an explosion of devices and apps,' says the Liverpool GP, a leading figure in a government-backed pilot evaluating technology to assist chronic disease care.

Keeping an open mind will be vital for GPs, he argues. GPs have been 'brilliant' at adopting new technology to improve their working lives, but must now realise it can transform patient care.

In areas such as Liverpool, the fuse has already been lit. Dr Smith leads More Independent (Mi), a scheme funded by the government's technology strategy board.

This partnership of NHS and social organisations in Merseyside is rolling out technology such as fall detectors, epilepsy sensors, medication dispensers - even a talking microwave.

It aims to help patients with long-term conditions take control of their health and use technology to live independently.

The pilot, one of four across the country, is the next phase in the gradual adoption of telehealth and telecare services in the UK.

But some GPs still have doubts about how technology can improve outcomes, particularly because cost and clinical effectiveness evidence for telehealth remains limited.

Dr Smith believes there is now enough evidence to press ahead, but cautions against thinking these technologies are the 'final answer'. 'This is a dynamic, evolving scenario and the world today is completely different from the world three years ago.

'Three years ago, a device like a pulse oximeter was a couple of hundred quid or more. Now it's £25, so immediately it's accessible. In two or three years, who knows what it's going to be like.'

He accepts the case for telehealth 'wasn't well made' by the major government RCT, the Whole System Demonstrator project.

This suggested telehealth devices could cut hospital admissions by 18% and deaths by 46%, although researchers said it was unlikely they would be cost-effective.

Dr Smith insists the study was not realistic. Now, he says, the technology is more affordable and service redesign more extensive.

While cost must be considered, it should not be a barrier to innovation, he says, and neither should the long-standing problem of how to release savings made in secondary care.

But GPs cannot continue working as they are, he adds. Telehealth, telecare and other technologies are a chance for a new approach, he says, but only part of the solution.

The push for greater self-care must be accompanied by a more dramatic change in the most fundamental element in medicine: the relationship between doctor and patient.

Proactive care

Dr Smith believes the move towards more proactive care in general practice, to keep people well so they need fewer services, is the start of a new era for the NHS. In the past, he says, someone unwell sought advice from friends and family. By the 20th century, they visited their doctor.

'We need to move on and think about how we help people,' he says. 'The ideal would be that if a person can monitor their own BP, they don't need any intervention unless their BP is out of control.'

Recently, there has been a surge in health-related apps, with big technology firms adding health-tracking sensors to their latest models.

As data from these technologies are increasingly shared with GPs, they must be mindful of privacy and data protection. These matters were brought sharply into focus by the debacle, which has made many GPs sceptical about widespread data sharing.

Dr Smith is adamant that, while it is important to protect patient confidentiality, it is still important to share data, because of the benefits telecare can bring.

But will these technologies have a visible effect on GP workload? Dr Smith believes it is 'likely' consultations will decrease, but recognises there may be reluctance to take on this new approach.

For the past few years, his practice has suggested that patients buy their own BP monitors and present the data to the surgery.

He acknowledges concerns about the 'tsunami of data' this approach can generate, but says well-designed systems should only trigger alerts when patients' readings fall above or below set levels.

Dr Smith argues no-one can avoid the flood of data about to hit the NHS - and GPs had better be ready. 'We can't be like King Canute, trying to push back the tide.

'The task for GPs is to understand the environment they're operating in and use the technology to its best advantage to help the patient, and help themselves.'

How to commission successful telehealth services

Download the latest special report providing practical advice on how CCGs can improve the commissioning of technology enabled care services, in association with Simple Telehealth.

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