How Lancashire's doctors' surgeries are going digital - and what it means for patients

Almost two thirds of GP practices across Lancashire and South Cumbria are now offering online consultations, as the NHS in the region continues to roll out a programme designed to bring more digital technology into doctors’ surgeries.

Nearly a million patients can now access the virtual visits, which may still ultimately result in a real-world appointment if a medic thinks it is necessary.

Steve Riley and Jeanette Barnard are hoping that digital monitoring of patients' conditions could make consultations more effective

Steve Riley and Jeanette Barnard are hoping that digital monitoring of patients' conditions could make consultations more effective

The consultations can be carried out via a new app which is being promoted in practices across the region or through other online communication tools.

St. Mary’s Health Centre in Penwortham is awaiting some final technical tweaks before it, too, can welcome its first patients on screen rather than in person.

Nursing manager Jeanette Barnard is excited by the prospect of online appointments - while recognising their limitations.

“It depends on what the patient is presenting with and any conditions they’ve got,” she explains.

Patients could soon be popping up on screen rather than in person

Patients could soon be popping up on screen rather than in person

“If you were doing a Facetime consultation, you obviously couldn’t take somebody’s temperature or measure their blood sugar."

Practice nurse Steve Riley was interviewed for his job at the surgery via a webcam, because he used to live 300 miles away on the south coast. He says that in-vision appointments are equally practical and could be just as beneficial.

“For the right type of patient, it’s going to be phenomenal. We don’t have to get everybody in and do a pulse, temperature and blood pressure check.

“Obviously, there are things we should be doing to monitor patients and look for deterioration. But a lot of the time, patients can describe what the problem is - and if they are presenting via video, we can get that information from them.

Stephanie Zakrzewski believes general practice - and its patients - can benefit from a digital outlook

Stephanie Zakrzewski believes general practice - and its patients - can benefit from a digital outlook

“There will be some people who we still want to monitor and get baseline [measurements] from, but there will be other people who might just [need] an increase in medication,” Steve predicts.

Across the county in the Ribble Valley, Steve’s counterpart at the Whalley Medical Centre, Stephanie Zakrzewski, says a shift to digital interaction would not leave patients shortchanged - but could actually expand the services available to them.

“It’s complementary and additional to what we already have - we are not reducing the contact. I’ve got patients who work full-time Monday to Friday who can’t come for their reviews for conditions like asthma.

“It might be that I could do an online consultation with those patients, watch them taking their inhalers and answer any questions they’ve got. They can then get a review that they may otherwise never have had,” Stephanie adds.

NHS bosses in the region suggest that rethinking the traditional appointment scenario across both the GP and hospital settings could prove more convenient for patients - and more efficient for a health service under strain.

Amanda Thornton, digital clinical health lead at Lancashire and South Cumbria's Integrated Care System (ICS) denies that a “digital first” approach risks leaving some patients disadvantaged - and dehumanising the interaction with doctors.

“We cannot design a system which excludes people who aren’t very digitally literate, so we have to be mindful of them and we are.

“Digital will never replace the talent or compassion of our staff, we still need that as much as ever - but we also need the people.

“We’ve got 1,200 nurse vacancies in the region and GPs are leaving the profession, so we’ve got to free-up every single clinician and digitally enable them - that would leave more time for the face-to-face appointments with those patients who really need them,” Amanda claims.

The classic receptionist’s phrase, “The doctor will see you now”, looks set to take on a whole new meaning.

THE DIGITAL TOOLS COMING TO A SURGERY NEAR YOU

The technology deployed to treat patients within the NHS is advancing on what seems like a daily basis - but the technology used to track and interact with them has, according to some who work on the frontline, not kept pace with other parts of our everyday lives.

“It has always amazed me that you can shop online and book flights, hotels and restaurants - but health seems to have been left behind,” says Jeanette Barnard, nursing manager at St. Mary’s Health Centre in Penwortham.

That has begun to change over the last twelve months after the NHS in Lancashire and South Cumbria started to support an app which enables direct digital contact between GP practices and their patients.

While people are free to use the plethora of other apps which offer similar services - including an official NHS version - the health service in the region has put its weight behind the “My GP” app, after a procurement process last year. More than 156,000 people have so far downloaded it across the region and work is now underway to introduce it in more practices in across Lancashire - with the aim of covering 90 percent of the population.

Steve Riley, practice nurse at St. Mary’s, says that the opportunity for patients to use the app to monitor their own conditions in between visits to the surgery could make those trips more effective - by providing clinicians with real-time data on the likes of asthma, diabetes and chronic obstructive pulmonary disease.

“If patients know what is normal for them and what they need to be looking out for, that can help target our consultations,” he explains.

“How I respond [to the collated data] will be very different than if a patient just came in for a routine appointment - meaning we’re giving the right treatment at the right time.”

Nursing manager Jeanette Barnard hopes that the interactivity of the app will make it more effective than traditional methods of handing out medical advice.

“Previously, you would have just given a patient a leaflet about their condition, but if they’ve got the app, you can include [tailored information] and anything which might highlight to them that something isn’t right,” she says.

“We’ve also really pushed our Facebook page for campaigns to promote things like flu vaccination clinics and cervical screening, where uptake is low.”

Whalley Medical Centre’s practice nurse, Stephanie Zakrzewski, is one of the region’s “digital champions”, charged with bringing the NHS frontline into the twenty-first century.

When she started her career in the early 1980s, she could never have imagined the technological advancements of the next four decades. But she suggests that they have the power to transform the biggest and smallest aspects of how a GP surgery operates - from monitoring health to ordering tablets via a tablet.

“If patients have got a long-term condition, they might get half an hour a year for check ups - so they're for the rest of the time to look after themselves. But we can fill that gap through digital support, which can be 24/7,” says Stephanie, who has recently designed a series of health information animations which are now being used across Lancashire and South Cumbria.

“Then there is the basic booking of appointments and ordering repeat prescriptions - they are all things that people would normally be calling up for.

“Now, the patient doesn’t have to worry about doing these things during surgery hours - and it also frees up staff time to do other things.”

But with more than five million people across the UK not online at all or not using the internet regularly - almost 80 percent of whom are over 65, according to figures from the Office for National Statistics - will some patients miss out on the perceived benefits of a brave new digital world?

“In the last few years, we’ve seen patients becoming more digital-savvy, so they are wanting to do things [online],” Stephanie says.

“We used to have this massive presumption that patients of a certain age don’t have access to smartphones or the internet, but they do - so it’s something we need to embrace.

“But social media and apps will never replace face-to-face contact.”

‘PATIENTS MUST BE AT THE FOREFRONT OF THE DIGITAL FUTURE’

The Patients’ Association, which represents the interests of NHS users, described technological innovations in healthcare as “exciting” - but warned that the potential downside of going digital must not be overlooked.

“Any prospective patient-facing interaction has to be fully and properly tested – this means it needs to be independently-verified with patients at the centre of piloting any software,” the organisation’s chief executive Rachel Power said.

“It’s crucial to understand the potential as well as the risk of this type of innovation – and patients are the best judge of determining how care can be delivered in practice.

“Patient safety must be of paramount importance at all times and adequate safeguards must be in place to ensure the utmost protection of patients’ personal data. It is vital that the security of the identity verification processes being used on any technology used to access patient data, are of the highest international security standards.

“In addition, all technologies must involve patient interactions that are based on sound clinical evidence with robust quality assurance of interventions to ensure safety of care for patients at all times."

IN NUMBERS

962,000 - number of patients eligible for an online consultation in Lancashire and South Cumbria

17,000 - primary care appointments booked by app in Lancashire and South Cumbria (August 2019)

1,800 - number of patients who chose an alternative service to a GP appointment when offered one via an app (August 2019)