What enabled rapid digital change in primary care during the Covid-19 pandemic?

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In the early days of the Covid-19 pandemic, general practice in England transformed itself, rapidly adopting digital approaches to triaging and consulting at a speed that would have been unthinkable just months before. The timeline set out in the NHS Long Term Plan, which promised every patient the ‘right’ to digital primary care services by 2024, has been blown away.

There’s a lot we can learn from this extraordinary roll-out. In the summer of 2020, The King’s Fund was commissioned by the Department of Health and Social Care to look at what had helped, or hindered, this rapid implementation so that the gains can be sustained.

We found that during the first phase of the pandemic lots of the key processes and mechanisms that had been in place before were bypassed or streamlined. ‘Necessity is the mother of invention’ was a phrase we heard a lot from practices and new products were often implemented without a formal procurement process or, where commissioners did get involved, it was very light touch, with the proviso that the decisions would be reviewed when there was more time to do so.

‘In the early days of the Covid-19 pandemic, general practice in England transformed itself, rapidly adopting digital approaches to triaging and consulting at a speed that would have been unthinkable just months before’

In fact, one of the key findings of our research was that practices themselves were supported to be the key drivers of change and were able to react much more rapidly than national NHS bodies and clinical commissioning groups and worked directly with suppliers. In turn the suppliers, particularly the smaller suppliers who were able to be more agile and responsive, rolled out solutions in a matter of days directly to practices, which could bypass previous procurement processes to implement the tools they chose. This was particularly helped by several companies initially offering software solutions free of charge and without needing complex installation, making them a quick and easy solution to implement.

There is a clear challenge to ensure that excess bureaucracy and complexity doesn’t return. We heard that GPs want to be able to exercise informed choice over the technology that they implement, rather than having it imposed on them and that suppliers don’t want to duplicate effort unnecessarily at regional level if they had already met national standards. We heard mixed messages about the benefits or disadvantages of system-wide procurement but heard definitively that practices and networks want more say.

During the pandemic there was a clear burning platform — a desire to protect both patients and staff —which overrode lots of the cultural barriers and resistance to implementing digital change that had existed in some practices before the pandemic. But when more normal times resume, there will need to be high-quality local support to practices and local health systems to support implementation of digital tools. We heard from our interviews that frontline staff would rather local health systems concentrated on support for implementation, with better change management support in particular, rather than procurement.

'Inequalities in digital access persist, and there will need to be a sustained focus on making sure people’s access to care isn’t affected'

While the pace of change was phenomenal, the process during the pandemic wasn’t entirely smooth. It’s clear that while practices adopted technology at pace, other parts of the health system couldn’t keep up. In addition, things like evaluation, data collection and outcomes measurement need to now be put in place and some of the governance processes and regulations that were bypassed now need to be reviewed to make sure that the changes made will stand the test of time.

There are other longstanding issues to address that pre-date the pandemic — access to adequate hardware and WiFi in practices is still a problem as are issues around how different digital products interact. Inequalities in digital access persist, and there will need to be a sustained focus on making sure people’s access to care isn’t affected by their access to technology or their ability to communicate in writing, for example.

There is a huge amount of research ongoing about the best digital tools to use; about how to reduce digital exclusion and about how to best support patients using technology. But the incredible transformation of general practice has given us some important insights that should help improve how digital change is implemented in the NHS for the future.

Digital transformation, general practice and Covid-19

Our new report examines the factors that enabled the rapid uptake of digital technologies in general practice during the pandemic.

Read the report

Comments

STEPHANIE LEWSEY

Position
Informal Carer,
Organisation
public
Comment date
11 February 2021

I'm an informal carer with my own physical and mental health issues. I have difficulties with the phone and technology. Our surgery pre-covid pushed digital technology, and have pushed it even more with the pandemic. You can no longer just make an appointment in the surgery or by phone. You have to complete E-Consult and await a doctor to call. I struggle to understand the questions and it takes so long to complete. There are things I do not wish to discuss over the phone as my family can hear the whole conversation. Nothing is private when using digital technology. I feel very excluded and am not being monitored by our GP Surgery.

Paul

Position
Lead Tissue Viability Nurse Specialist,
Organisation
University Hospitals of Derby & Burton NHS Foundation Trust
Comment date
12 February 2021

I think until the government recognises that the only way forward is an integrated digital infrastructure where particularly software is truly integrated and compatible and accessible to all NHS organisations and is willing to invest in what is needed and to engage, truly engage with the clinicians on the shop floor then nothing will change and this utterly fragmented mess of an IT infrastructure the NHS has will only continue. Exacerbated by NHS organisations being left to purchase what software/hardware they think they need without any governmental direction or focus which is what is needed. The NHS digital infrastructure needs to be seamless with no incompatibility between systems and software so that clinicians can access what they need to when they need to. The NHS should learn from the Police and the Security services and invest in a national digital infrastructure which is what is needed. This is the 21st century and yet still organisations have difficulty communicating patient information to each other because of incompatibility and security concerns. This should not be happening!!

Catherine Thomson

Position
Trainee ACP and Physiotherapist,
Organisation
Manchester Foundation Trust
Comment date
12 February 2021

Thank you for your report. I was wondering what patients' experiences have been of this change and what the clinical outcomes have been of moving clinical reviews online in Primary Care? I was also wondering what the experience has been for other stakeholders such as the ambulance service and other primary care and acute care services- as the move online of GP surgeries has, I would assume, had a knock on effect on more than just the surgeries themselves, the commissioning bodies and the IT companies. I would be interested to hear your views on this.

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