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

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.