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When the wait is too long: Revolutionising access to primary care



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Dr Farzad Entikabi, co-founder and Medical Director at digital healthcare company Doctor Care Anywhere, and NHS GP partner in a North London surgery, tells Kathryn Reilly how he is working to help relieve the enormous burden that face-to-face GP appointments place on the NHS

primary care

GPs are very often both the first and the last port of call in the NHS. About 90 per cent of all contacts with the NHS occur in general practice, and every weekday about 1.3 million consultations take place in doctors’ surgeries in England. The UK model of primary care is admired around the world, and there have been many attempts to replicate it in other countries.

But all is not well with general practice. The NHS is facing its biggest financial challenge, and GPs at the health service frontline are feeling the impact most of all. An ageing population, with a greater proportion of vulnerable patients, is imposing a huge burden on primary care at a time of unprecedented funding constraints and staff shortages. Across the UK, waiting times for GP appointments have increased, and on a typical day a GP may be expected to see between 30 and 40 patients with increasingly complex needs. Adding to this ‘access challenge’ is the fact that more than 1,500 fully qualified GPs are leaving the workforce each year.

The shift away from the hospitals

Current NHS policy directs that the burden of care be shifted from hospitals into the community, so the pressure on GPs is increasing dramatically. In addition, the extreme budget cuts in adult social care at a time of increased demand for those very services often mean that their provision needs to be picked up and covered by general practice. The average waiting time for a routine GP appointment is now just under two weeks, and is predicted to rise to 17 days in 2017.

The strain is also reverberating in the emergency sector. Around 37 per cent of people turning up to Accident & Emergency (A&E) just need advice, meaning that there were nearly 9 million ‘unnecessary’ A&E visits last year alone. The crisis in primary care affects all sections of the community.

Dr Entikabi’Doctor Care Anywhere asked YouGov to carry out a survey of more than 1,000 employees. ‘What we found was troubling,’ he says. ‘Difficulty booking appointments outside working hours emerged as one of the biggest barriers to accessing primary healthcare, and 34 per cent of respondents had made a health problem worse by cancelling, missing or postponing a GP appointment because of work commitments.’

Not throwing money at it

Such a situation is not sustainable, and the government is under pressure to provide additional funding, particularly for primary care. But money alone can’t solve these structural problems. The NHS must harness innovative technologies that can transform the way people engage with healthcare. Society is changing, and people demand greater control over their own health – a development that presents the NHS with both challenges and opportunities.

Just as the digital revolution has fundamentally and permanently changed consumer access in a range of markets – from hotels and retail to music and minicabs – new technology is driving unprecedented advances in healthcare, both in the diagnosis, monitoring and treatment of illnesses, but also in how healthcare is delivered.

‘The advent of online GPs and telehealth is providing part of the solution to the funding and resource pressures in primary healthcare. But given that about 70 per cent of GP appointments could be conducted by video, this really is just the beginning,’ Dr Entikabi explains.

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For patients, the advantages of virtual appointments are clear. They are more likely to be able to arrange an appointment at their convenience, without having to travel to and from a health centre therefore requiring less time off work, for example. ‘This means that patients are less likely to cancel or postpone an appointment, which is a significant issue currently for GPs. Doctors surgeries are losing the equivalent of one GP per week because patients don’t show up for appointments. Around 12 million appointments are missed each year, costing the NHS £160 million annually, so anything that addresses this issue must be welcomed,’ he continues.

‘We also know that telephone and video consultations have a significant and positive impact on waiting times, helping GPs to manage the flow of patients more effectively. This helps with the delivery of care and leads to better outcomes, which, in turn, helps primary care providers with resource planning and allocation. Remote consultations also allow clinical service providers and commissioners to redesign the layout of surgeries, making additional space available to expand community services, such as diabetes and dementia care. Improved access to GP services also benefits the rest of the NHS.’

No time to be ill

The Doctor Care Anywhere/YouGov survey has also highlighted ‘presenteeism’ as a widespread issue, with over a third (37 per cent) of respondents admitting that in the past year they have stayed at their desk despite being so unwell that the quality of their work was affected. This benefits no one. Employers could provide a virtual GP as part of their employee benefits and health/wellbeing offering, which would foster a culture of proactive and preventative healthcare management at work, and help tackle presenteeism by encouraging employees to seek the right care at the right time.

‘These are the reasons that we founded Doctor Care Anywhere,’ Dr Entikabi says. ‘The service offers access 365 days a year, and patients benefit from simple, efficient access to a GP wherever they are in the world. Moreover, once the consultation is under way, Doctor Care Anywhere GPs have 20 minutes to listen to patients and answer their questions, meaning they are less likely to leave the consultation with unaddressed concerns.

Dr Farzad Entikabi

Dr Farzad Entikabi

We recently launched a new version of our platform, which provides members with greater flexibility to manage their day-to-day healthcare needs. Members can book video and phone GP appointments, get expert advice on their health concerns and, where appropriate, receive prescriptions, specialist referrals and medical certificates, as well as being sent to an in-person GP for clinical examinations and diagnostic tests in the small number of cases where this is required. Private prescriptions are delivered or sent to the most convenient pharmacy, or medication is delivered, so that whether they’re at home or away members can get the medicine they need. These ePrescriptions are accepted at more than 1,000 pharmacies nationwide. Members can now set up their NHS repeat prescription ordering online and avoid the hassle of going to and from their NHS GP. All consultation notes and documents are uploaded to the member’s Doctor Care Anywhere medical record and available to download and share with the patient’s other healthcare providers following a consultation. Plus we have a health tracking app to monitor symptoms linked to over 30 long-term medical conditions, as well as lifestyle factors.’

For businesses, many workday absences are attributed to time spent visiting a doctor. Illness costs the UK economy more than £30 billion a year in recruitment, absences and lost output. Increasingly, the public and companies are turning to telehealth as a solution to their needs. The NHS is beginning to realise the benefits of improved access to healthcare through digital technologies. But progress is understandably slow, Dr Entikabi believes, given the multitude of priorities and issues that the NHS is trying to deal with. ‘I strongly believe that a step change is needed to make the transformative leap that will embed telehealth in the universal delivery of primary care.’

About the author

Journalist and editor Kathryn Reilly has worked in consumer, contract and medical writing for more than 20 years.

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