Spoke at a ‘Future of the NHS’ conference this week with Clare Gerada, Chair of the Council of the Royal College of General Practitioners and Roy Lilley, broadcaster and commentator on the NHS. Both painted a pretty bleak picture of the future of the NHS, as one that will warp, even suffer partial collapse, under the strain of increasing demand. We saw signs of this today in the North Staffs case.
Gilding by Lilley
As Roy Lilley so eloquently, and wittily, stated – we’re sleepwalking into a financial disaster. The bottom line, literally, is that age and demand are rising but costs are flat-lining. This will lead to a £20 billion gap in funding by 2015 (not that far off). We have no growth, or real prospect of growth in that timescale, so the government cannot and will not come up with the money. His solution is to use the Tesco model – work out exactly where large centres of excellence should be placed then open up lots of NHS Extra shops to cope with GP demand. I agree with this. We have far too many ‘don’t close our A&E’ protesters when what we need is good data and good planning. I also agree with his observation that the private commissioning argument is a bit of a red herring as it doesn’t really deliver the savings. My own view is that this is not enough, and impractical, as many of the sites are already chosen and tied into PFI agreements. It is far too difficult now, practically and politically, to change the geography of the NHS.
Loud and Clare
Clare Gerada had to defend her constituency – GPs, but even she says that the abandonment of out of hours work was a mistake. She also hinted at far more use of texting and Skype with patients, which she does in her London practice. However, when questioned by the audience she had to admit that the costs of training a GP (north of £300,000) and replacing early retirement GPs (x2.2 replacement costs) is high. In the end she had no really strong ideas in terms of closing the funding gap.
Anyway, here were my 7 ideas:
1. Massive investment in NHS Direct
Launched as a nationwide telephone service in 2000, then as a website in 2010 and mobile service in 2011, NHS Direct has been a huge success. Sure, it’s a bit shallow and risk averse, but it is well used and well liked by those who use it, funnelling patients away from expensive Ambulance, A&E or GP visits (see graphic). It’s also available 24/7/365 and serves the population well in the face of the collapse of the GP out of hours service.
First, we need to Napsterise or disintermediate patient advice away from expensive hospital and GP surgeries by increasing the marketing, resources for this service provided over the telephone and more importantly, online, where the transaction costs are minimal. Second, we need to make this service deeper and more sophisticated by adding texting, skype, social networking and flagging other online resources for worried inquirers, possible giving the service access to patient records.
2. GPs must communicate with patients using new media
GPs and their practices are still, largely, stuck in the age of paper and telephone communication and even then it’s the patient who has to do all the running. Their lack of awareness and use of texting, email, social media and services such as Skype is astonishing. Email, in particular, needs to n used more,especiallly for permission-granted distribution of results. I'm tired of having to phone up my practice for 'results'. Smarter communication will reduce the number of necessary visits and transaction costs. However, the easier first target is 'no-shows'. In a service that is free at the point of service you either charge or manage this financial leak. Medical professionals are expensive, so no-shows are expensive. We know that the solution is to nudge patients into remembering or feeling obliged to turn up.
3. GP training online
Far too much GP and other health professional training is appalling Foxes Glacier Mints on the table, flipchart sessions in awful hotels. I know, I’ve attended a few. This has to stop. They’re of poor quality, inconsistent and far too expensive to run. Health professionals need consistent, high quality online training delivered, not locally, but nationwide.
4. GP networks online
Practices need to start by getting their clusters of GPs and health professionals using online networks for personal development and not relying on flipchart sessions for erratic updates. This is the 21st century, and as medicine has a strong scientific base, that makes real practice change on the frontline, there is no excuse for being slow in doing this quickly, and fast means online.
5. Patient online learning
As we are facing a tsunami of problems with obesity, diabetes, mental health and many other conditions, a real effort must be made to use online media to alleviate the pressure. Obesity, especially in the young must be tackled by going where they hang out and that’s on Facebook, Twitter and other social media. Similarly with mental health, where early trials have shown good results for young people through the regular use of texting and other social media. Patients with chronic diseases have already created great networks of mutual support – we must drive harder and faster on this.
Patients must be encouraged to use their mobiles for health. This means exercise checking (apps already exist), self-checking blood pressure, peak flow, heart-rate, glucose etc. It also means behavioural nudges around diet, exercise and self-awareness of medical problems. It is foolish to ignore the one device that is powerful, personal and portable. Smart phones are already packed with sensors such as GPS, accelerators, compasses and so on, it’s only a matter of time before they have cheap and easy to sue medical sensors.
My car has over 50m processors, making thousands of decision a second. It knows more about itself than I do about my own body, or my GP. We must get real about data. The X-foundation has offered a$10 million prize, and called it the Tricorder Prize, named after the Star Trek device that was used to scan and diagnose people on the spot. Remember that the Star Trek crew could ask their handheld device any question and it would give them an answer. I never dreamt that that this would happen in my lifetime but it has, with Google. Several companies are working on handheld devices that will read physiological, genetic and body fluid data, with good analytic software that will provide useful and practical advice. Great strides have been made recently with glucometers and other patient devices such as iHealth, which all plug into your iPhone or tablet. This promises to dramatically reduce the cost of tests and diagnosis, as it Napsterises or disintermediates a lot of what is currently done by expensive health professionals.
It’s time for an online revolution in health that Napsterises very expensive services and pushes the load back towards the patients. The current service where you only see your Doctor when something almost catastrophic happens is way past its sell by date. We need to know more about our own bodies and take some responsibility for our own health. Google, Facebook and Amazon know more about me than my GP!