Using technology to personalise and transform healthcare is the rather sizeable task the NHS has set itself for the next five years.
On the table are some big ideas like support for development of personalised medicines and greater self-management of conditions as well as some more specific measures such as adding IT funding to GP payments.
Framework for improving care by 2020
Personalised Health and Care 2020 is a framework that was published by the National Information Board late last year. It sets out 75 recommendations which it believes will enable IT to make life better for patients and professionals.
The NIB, which represents 20 health and local government organisations interested in IT, claims its proposals are key to the NHS meeting both its efficiency and quality challenges.
It suggests best value for taxpayers may be delivered at GP level by putting funding for IT into capitation payments when the GP systems of choice (GPSoC) national contract ends in 2018 and proposes that the NHS support projects on personalised medicine projects such as cell therapy.
It also sets targets for all NHS records to be to be digital and interoperable by 2020 and says work should be completed next year on a ‘whole system’ approach to the use of personal and confidential data.
The framework also says that patients should have online access to records in all care settings and be able to add their own comments and preferences to their records by 2018.
NHS Choices will also be developed so that patients and GPs can use it for e-referrals appointment booking and repeat prescription ordering as well as being the access point for NHS 111.
In addition, the NIB says it will trial patients having their own mobile care record, invest in technology to support innovative ways of delivering services and suggests that GPs might be able to prescribe apps for patients once a kite marking system for apps is put in place.
Benefits for GPs
Dr Paul Cundy, a GP in south west London and chair of the BMA GP committee’s IT sub-committee describes the idea that GPs should be free to buy systems from any supplier as ‘very important’.
‘I think this document has picked up some of the lessons of the debacle of the National Programme and correctly understood the need for local organisations to make their own decisions on systems from approved lists backed up by standards and national infrastructure,’ he says.
He also welcomes the commitment to build patients’ trust in what happens to their data. However, Dr Paul Hodgkin, a former Sheffield GP and chair of Patient Opinion, says his personal view is that the National Information Board could have gone much further with its proposals.
‘They have missed out on the things that would improve patient confidence in what’s happening to their information so that, for example, instead of just being able to look at the record they could toggle to a view of what a GP’s receptionists can see of their record so they know they are not able to see non-contextual stuff,’ he says.
Patient access to records
The proposal that patients will be able to view and annotate the GP record is also bound to create challenges. Dr Hodgkin points out that decisions about who is responsible for acting on the information added by patients will be needed before this aspect of the system gets off the ground.
Dr Simon de Lusignan, a Guildford GP and professor primary care at Surrey University, adds: ‘The primary purpose of GP records at the moment is not an information tool for patients so we need to look at smart ways of presenting that information so that it leads to better health outcomes.’
Dr Nav Charna, a GP in Mitcham, Surrey, and chair of the National Association of Primary Care, is also a huge supporter of the personalisation agenda. ‘It is absolutely the right way to go but sometimes we get distracted by the process elements like care record access which are not in themselves an end point.’
He sees making information available to patients at the right time and place when they need it, creating systems to enable them to self-care more easily and developing integrated care records as other elements that will help to promote greater health and wellbeing.
However, Dr Charna questions the timescales suggested for making these changes and describes the target for patients to be able to write in all their records by 2018 as ‘hugely ambitious.’
However, Dr Cundy believes that the targets in the framework are ‘potentially realisable’. He points out that general practice is already producing digital records, using SNOMED coding and has contractual commitments to make summary care records available online to patients by this March and provide patients with online access to more of their records in 2015/16.
What should GPs do now?
Dr Cundy says that in advance of any changes to funding for IT systems, GPs should prepare to exercise their rights under the revamped GPSoC programme which will come into effect in April, allowing practices to select from an approved catalogue of systems.
‘It means they can put together bundles of software rather than having to taking single dumps from one supplier,’ he says.
In terms of the wider personalised care agenda, Dr Cundy also cautions that any change should be backed by research.
‘There’s very little spare capacity in the system at the moment so if we do something different it has got to be shown to be better than the thing we don’t do in order to do this,' he says.
|Timeline for expanding the use of technology in the NHS|
March 2015 – all patients to have online access to the SCR in their GP record
April 2016 – plans published for moving to a whole-system, consent–based approach to use of personal and confidential data
2018 – clinicians in primary, urgent and emergency care operating without paper
March 2018 – all patients able to record comments and preferences on their records
April 2018 – GPSoC ends and possibility that funding could return to individual practices
2020 – all care records digital and interoperable, whole health system using SNOMED coding