Much has been learnt from the recent operational response to COVID-19 in terms of the way in which different healthcare providers have responded to the pandemic at short notice.
Elements of the operational response perhaps set the scene for what future provision of healthcare might look like.
In this article, we first look at the differing operational responses, primarily driven by local demand, and then move on to the digital response which has aided the overall operational response.
At the start of the pandemic, NHS England issued guidance which freed up inpatient and critical care capacity. We saw postponement of non-urgent elective surgery, discharge of in-patients who were medically fit to leave and the buying in of capacity from the independent sector.
Routine responsibilities were removed from clinicians, as a redirection of staff took place so as to maximise availability of healthcare professionals. This was supported by the increased provision of telephone based and video consultations.
We also continue to see an acceleration of partnering between healthcare institutions. A greater shift from competition to collaboration.
Benefits of these steps have included innovation at an operational level and a recognition of the need to accelerate integration of systems. Much was driven by local demand. For example, the operational response from Primary Care Networks (PCNs) has included greater collaboration between PCNs.
By way of example, three PCNs covering 20 GP Practices in Gloucestershire shared their workforce. They split surgeries between those dedicated to COVID-19 or suspected COVID-19 patients, and those dedicated to patients without COVID-19 or those showing no signs of COVID-19.
We continue to see the further empowering of patients. Patients have shown a greater willingness to self-manage conditions. This has been particularly true of minor self-limiting difficulties, which has presented an opportunity for healthcare providers to refocus primary care towards those patients with the greatest need.
An acceleration in the application/use of telephone and video consultations both in Primary and Secondary Care has been seen.
The benefits of shorter consultations freeing up clinicians’ time have been significant. However, ‘digital poverty’ and ‘digital inequality’ remains an ongoing difficulty. Many are without a smartphone or without secure and reliable broadband. Others struggle in terms of ability to use the technology made available. The ‘digital divide’ isolates and risks endangering patients.
However, the benefits of technology, if the care can be got right, are clear in terms of safety to patients, speed of provision of a consultation and convenience for patients.
Patients deemed too high risk to attend GP surgeries in person have been able to attend consultations remotely. This has also brought with it the benefit of protecting GPs and practice nurses from potential exposure to COVID-19.
Such developments are not without difficulty. One element hard to recreate via a digital platform is the ‘door handle moment’ when a patient confirms the real issue to the GP at the point of leaving the consultation.
Meetings between GP Practices, NHS Trusts and care homes have also taken place remotely via video call. Perhaps laying the groundwork for further improvements in multi-agency working. There has been greater support for the work done by NHSx, who, prior to the pandemic, were tasked with best practice in terms of technology, data sharing and transparency.
In terms of future possibilities, scanning technology, which is used so well in the retail sector by supermarkets, is yet to be part of integrated care within the NHS. Whilst scanning is used locally, it is not integrated. Hurdles that need to be overcome include IT systems not talking to each other and difficulties integrating legacy systems.
The benefits of technology, allowing easy transfer of data, real-time audit and an ability to trace would all increase efficiency and aid patient safety. Its value would be in providing better care to patients.
The operational response during, and digital solutions accelerated by the pandemic can now be built on for the future.
Recent experience has afforded an opportunity to begin testing potential long-term solutions. Healthcare professionals who had reservations about digital solutions or clinicians who were simply not able to adopt such systems owing to pressure of time or lack of availability of platforms and resources, have, by necessity, had to adopt new ways of working.
A blended approach allowing for interaction of patients with knowledgeable, understanding and caring healthcare professionals, assisted by the advancements in technology, offers a bright future.
If digital solutions are to be improved then listening to patient feedback and the experience of clinicians providing the care is key. Technology is merely an enabler to help patients and to help staff so that better and safer care is provided.