7 day access – let’s think differently

Last week I spoke at the Westminster Health Forum on “The future for 7-day NHS services in primary and secondary care settings”. My presentation was a topic close to my heart – Utilising technology to improve access.

Now the event gathered together the great and the good from the NHS as you’d expect. Lots of discussion about how very difficult it is, how death rates for those admitted on a weekend are up to 16% higher than during the week. The shortage of many different types of medical staff – nurses, GPs, paramedics, radiologists, A&E doctors etc. The lack of resources and, of course, the fact that demand isn’t going away but is very much on the increase.

It was all very depressing I have to say.

However there were two comments – from the audience, not the speakers – that have really stuck in my mind.

What is the cause of death at weekends?
Firstly, a pathologist (who carries out 200 autopsies a year so he must know) said “the causes of death are often related to what happens outside the hospital, rather than inside the hospital.” Such an obvious statement. However the point is, what exactly is the cause and can we stop blaming doctors or the fact that we can’t get a GP appointment out of hours?

Yes, these changes to 7 day access will be very demanding of people. Maureen Baker from the RCGPs commented that today there will be 1.2m patient consultations carried out by GPs – that’s 370m consultations per year. I really wanted to ask – how many of those consultations are face to face and how many are done remotely e.g. by skype, telephone or text; but sadly didn’t get the opportunity.

The Prime Ministers GP Challenge Fund covers 57 schemes, 150 federations, 2,500 providers and 18m patients and is one of the world’s largest programmes of its kind. The aims are about providing access that is right, but it’s not just about extending opening hours – consider the right place, at the right time, with the right care and the right person.

I was really interested to hear the findings from the Birmingham Vitality partnership which covers 70k patients and is now a Vanguard. Their aim was to provide digital healthcare that was both personalised and transactional. They say that 65% of all consultations are remote (either via telephone or skype), of which 75% are resolved remotely. There has been a 70% reduction in DNA (do not attend) equating to £300k savings, there has been a 15% increase in capacity and a 15-26% drop in A&E attendance.

Back to the fact that there are 370m consultations a year – imagine the time it would free up if 65% were done remotely?

“If we enable people through technology to access services it will free us up to spend time with those who need it most”

That’s what Dr Sam Everington, National GP advisor and GP in Tower Hamlets said last week at the Health and Care Innovations Expo. This has shown to be the case in Birmingham.

75% satisfaction – is this acceptable?
The second comment from the audience was this – 75% satisfaction isn’t acceptable. This relates to a stat from the RCGPs which was “75% of patients said they were happy with GP opening hours”.

Should we be settling for a quarter of people not being satisfied? I think not. But again, we can’t just blame the GP.

We need to get the whole system to change – housing, social care, health, the voluntary sector, families – they all have a role. But I strongly believe it can be done in a better way, with technology enabling care to be wrapped around an individual.

We’ve heard recently the results from Calderdale’s Quest for Quality in Care Homes (24 homes) initiative which uses technology as part of a multi-disciplinary approach to help maximise efficiencies across the health and social care economy, and enable people to live healthier and happier lives, with greater control of their own care.

Results so far show that for the Quest for Quality care homes:

• The cost of hospital stays has reduced from £3.23m in 2013/14 to £2.77m in 2014/15 saving £456,166
• Emergency admissions are down 25% year-on-year (March 2015) from 1,261 to 949
• Hospital stays are down 26% year-on-year (as at March 2015)
• Hospital bed days used has decreased by 16% year-on-year (as at March 2015), from 16,118 to 13,619 for 945 residents
• GP care home visits have reduced, with Quest for Quality care homes requiring 58% fewer visits than non-Quest homes

Technology is great for patients, but it’s also very much about supporting professionals in the efficient and productive delivery of health and care. It provides rich data – facts and information in advance that’s regularly collected, greatly enhances decision making and speeds up consultation. It can reduce travel times and resources, solving communication issues – e.g. when someone isn’t able to communicate their needs correctly. It enables early and safe discharge from hospital and technology is a great enabler to integration.

Where technology is working well we have to support those champions, free them up to innovate and spread good practice, don’t expect people to do it on top of their day job, and it really is a multi-disciplinary model involving professionals, yes but also the patient and the like of ourselves to get it right and build a sustainable model.