Frustrated by diminishing resources and an over-stretched system, GP and Chief Medical Officer Dr Anshumen Bhagat created the UK’s first doctor-on-demand app GPDQ (GP Delivered Quick). Here he advises potential developers on the key considerations they need to bear in mind when venturing into the digital healthcare space
A few statements have stood out to me in NHS England’s recent publications. Firstly, from the Five Year Forward Plan published in October 2014: ‘England is too diverse for a “one size fits all” call model’. Secondly, Professor Sir Malcolm Grant, Chairman of NHS England, quotes in his 14/15 – 16/17 NHS Business Plan, ‘There is no question that we have pushed our resources to the limit in committing to the plan’s deliverables. There is no scope for any further demands, without further resources’.
I am an NHS-trained GP, a supporter and advocate of the NHS. I am extremely proud and privileged to be part of an organisation that was founded over 60 years ago and commits to providing healthcare irrespective of income, social status and race, and has delivered huge outcomes to date. But we can’t get away from the fact that we can’t carry on as we are, given the pressures our NHS is facing today. Is innovation the solution?
The healthcare system has changed dramatically over the past decade. While the objective remains the same: – improved affordability, better customer satisfaction and better health outcomes – the way these objectives are met has changed because of advancing technology and an increasing pace of innovation.
Due to the transformation of the digital healthcare sector, we have seen an exponential growth of mobile apps in the healthcare ecosystem. GPDQ was the UK’s first GP-on-demand-app, but now in 2018, there are an abundance of mobile health solutions for patients.
With access to innovative technology, often the issue in healthcare is not creating a clever digital solution, but rather implementing this technology in a meaningful way that prioritises suitability for the patient and clinical outcomes above focussing on the technology itself.
The widespread availability of mobile health solutions presents an accessible, affordable and convenient opportunity. However, some medical professionals get so caught up in creating a seamless digital service that they lose sight of the importance of clinical quality whilst innovating.
As Professor Steve Field, CQC chief inspector of General Practice, recently said: ‘while innovation should be encouraged, it must never come at the expense of quality. As with all healthcare services, patient safety must be at the heart of all decisions around what kind of care is offered and how it is delivered.’
One of the biggest challenges for the UK’s medtech sector is striking a balance between embracing innovative technologies to create a service whilst effectively coping with the growing demand for that service – and having the ability to simultaneously deliver excellent clinical care. There is a risk that adopting new technologies can leave us with little time to focus on quality and what’s best for the patient.
When developing a mobile health solution such as GPDQ, it’s tempting to focus on the innovation around patient convenience and value to the exclusion of all else. However, I believe that patient care and quality should be the primary concern. A major part of ensuring quality is through offering a safe and reliable service that improves the overall outcome for the patient. Technology can play its part in this, for example through the use of electronic medical records, which are easily transferrable and accessible for clinicians. Electronic prescribing has been shown to reduce prescription errors by 50 per cent compared to handwritten ones.
GPDQ offers a face-to-face home or office visit for patients from an experienced GP along with the convenience of booking via a mobile app. Most of the reviews we receive from customers show that they benefited from the speed, ease and convenience of using the app, but were particularly impressed by the service from the GP themselves – the top-quality clinical care. This is a function of not only working with the best GPs, but also thinking about how we can enable them to be at their best. GPDQ offers an industry leading 25-minute consultation length as standard to allow enough time to cover everything thoroughly, and works with a range of innovative partners to equip our doctors with technology-enabled tools for diagnosis and treatment.
There are many telemedicine companies offering a virtual health solution for patients, and virtual consultations are a great tool to triage patients. However, healthcare requires a range of tools and access modes and, most importantly, care and empathy. There is often no substitute for a physical examination to keep things safe, and certainly no substitution for the human touch.
During Mobile World Congress 2017, one major hurdle highlighted in succeeding within digital healthcare was security. While opening up new areas of innovation, the IoT and Big Data brings technical challenges with data management and security for medical device developers.
Security is topical across all industries right now, with the impending introduction of the General Data Protection Regulation (GDPR) and increasing concern and awareness among consumers about what happens to their personal data. However, for medtech companies, any failures or breaches can be catastrophic for business relationships and trust. Some operators may be hesitant to expand into the digital health sector because of such high risks.
All this data from clinical and non-clinical sources needs to be protected as it is being shared across platforms to unlock new opportunities in health service innovation. Medtech companies need to ensure their privacy and security processes can cope with this data shift and take special care to securely transmit and store data, to avoid breaches.
Changing legislation remains to be one of the main causes of concern for medical device developers. Evolving regulations on the security, privacy, reliability and safety of medical devices can have a significant impact on the internal processes, as well as the profitability of medtech companies.
Developers must use adequate processes to ensure safety, reliability and security is stipulated by standards and regulations imposed by various governments and international regulatory bodies, such as The Care Quality Commission inspection that GPDQ has just undertaken. These regulations are constantly being updated, so contenders in the medtech industry need to be thorough and keep up-to-date on industry changes.
GPDQ was born out of my desire to help build a sustainable healthcare system in the UK. For me, community-based primary care is the key to achieving this. Every day, I work at the primary care frontline in the NHS, which is stretched and under a lot of pressure.
The concept that a patient wanting to see a GP has another option, which doesn’t involve putting pressure on other areas of the NHS (such as unnecessary attendance at A&E) is something that complements the system and enhances patient choice. The healthcare industry is experiencing a noticeable shift to a more retail-centric model that enables the consumer to own their healthcare decisions. By giving them choice, convenience and access, we are creating an army of empowered digitally savvy patients who can benefit from digital services to help themselves, rather than solely depending on the NHS.
However, I also firmly believe that the way for us as innovators to maximise patient benefit is to work in conjunction with the NHS to be free-at-the-point-of-need for as many people as possible. That’s why we’ve given a lot of thought to constructing the sort of home visiting service for the elderly that the NHS finds difficult to deliver, and which maximises the benefits for patients. This is only possible with a sufficient focus on quality.
Delivering the doctor to the door is in many ways an old-fashioned concept, but bringing it into the 21st century by using technology increases efficiency and creates significant savings when compared to the alternative. As the population ages and becomes less mobile, it’s a false economy not to respond with providing a service that keeps vulnerable patients out of the hospital system.
I believe it’s all about creating digital services and applications that help our customers, engage our customers and most importantly provide effective health solutions, no matter where that customer resides. Technology enables medical professionals, such as myself, to make this a reality.
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