Building a Digital First Future: Digital Primary Care Congress - - PowerPoint PPT Presentation

Building a Digital First Future: Digital Primary Care Congress

Chamber of Commerce, Manchester 5th of February 2020

8:00am – 15:15pm

#Convenzi s

Dimitri Varsamis

Senior Policy Lead, General Practice Strategy and Contracts at NHS England and Improvement

“Comparing drivers and delivery of digital- first general practice across California, Australia and New Zealand; lessons for the NHS.”

#Convenzi s

Comparing drivers and delivery of digital and digital-first general practice across Scandi-nordic, California, Australia and New Zealand; lessons for the NHS? Dimitri Varsamis PhD

Made possible with funding from the Winston Churchill Memorial Trust February 2020

4

I will talk about

• Why am I here
• What works well and why in:
• Norway,
• Sweden,
• Denmark,
• Australia,
• New Zealand,
• USA.

5

• Senior policy lead for digital primary care in the national GP

contract team

• digital-related commitments in the contract
• policy for GP payments and contracting in light of

emerging digital-first GP models.

• Churchill Fellow

https://www.wcmt.org.uk/

6

Churchill fellowship-related meetings

• Perx
• Australian Digital Health Agency
• Potential X
• MQ, AIHI,
• NSW Ministry of Health
• Healius
• Practice Hub, Avant
• Uni Western Sydney
• RACGP
• Telstra Health
• Precedence
• ANDHealth
• EMPHN and Alliance
• Uni of Melbourne
• DHHS, Telehealth VIC
• SEM PHN
• Uni of Melbourne
• NZ Ministry of Health
• Compass Health
• Home Care Medical
• Pro Care
• Waitemata District Health

Board

• ACESO
• Ministry of Health
• Vensa Health
• UCSF
• GE Ventures
• DrChrono
• SJV
• Kaiser P
• UCLA
• Kaiser P
• Google
• CHCF
• VA / RAND
• Anthem
• USC Center for Health System Innovation
• Wildflower health
• USC Center for Body Computing
• UCLA Health
• RAND
• Headspace
• Cedars Sinai
• Biocom
• DIT
• Lantum
• Cedars Sinai
• MD Insider
• Heal

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Common people

All healthcare systems are dealing with the same issues:

• Multiple Chronic Diseases,
• Ageing,
• Increase in Demand,
• Lifestyle,
• Access,
• Efficiency...

All healthcare systems are dealing with the same digital health issues:

• Interoperability,
• Balance between health data

protection and exploitation,

• Fragmentation,
• Clinician suspicion,
• Investment ...

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Health expenditure

9

Semantics and concepts

• Focus on systems and reform options, in terms of functions, not labels
• Are German citizens more insured that British, just because they call

their system insurance?

• Are the Dutch people dying in the streets due to rationing because their

system has the word social?

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What I heard and what I saw

Key issues at national governments level:

• Old organisation + New Technology = Costly Old Organisation

Digitising the present or towards a digital future?

• Hospitals as fortresses or lighthouses?
• Health systems that do not use seamless consumer-friendly

digital health, will be replaced by those who do I observed in every country :

• National top-down and emerging innovation at local level
• Struggle with digital across providers outside hospital: primary

care, general practice, community pharmacy or other community services

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Norway

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Norway – secondary

• 98% use the Internet. Second in the world after Iceland;
• In hospital care:
• Video conversations with patients at home are now approved

for use in specialist health services under certain conditions.

• Such consultations paid for, same rate as regular

consultations.

• Benefits: mostly for patients, employers; savings in transport
• costs. Not to healthcare system.
• A nationwide audit in Norway showed that, despite geographical

remoteness, a history of early adoption of telehealth, a strong policy push, and adoption in principle by 75% of all hospitals, fewer than 1% of outpatient consultations in participating specialties were actually undertaken via telehealth in 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688245/

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Norway – primary

• Technology is not used as much between patients and primary

health services.

• Due to:
• No policy encouragement for GPs to use video.
• GPs would need to pay for IT, fit into business model.
• The tariff system regulating payments for general

practitioners has explicitly forbidden charging consultation payments for video consultations.

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Sweden

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Sweden and digital general practice

Accessing primary care

• Until now, no legislation for the concept of registration with a primary

care provider, although used in practice a lot by the county councils. Rules akin to temporary resident / out-of-area urgent primary care

• Residents of one county can visit temporarily a GP when in another

county, with provider getting a fee.

• Recently, digital sub-contractor to a primary care centre in one county

council area have been pro-actively advertising and offering appointments to residents of other counties. All change?

• National inquiry into rules for registration and access to care in

light of digito-physical care models https://www.regeringen.se/4ad5e9/contentassets/6e3786584628447986 30946d5bf12fc3/digifysiskt-vardval-_-tillganglig-primarvard-baserad-pa- behov-och-kontinuitet.pdf

• English summary on page 35

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Sweden and digital general practice

On the concept of registration:

• The Inquiry proposed that all primary care users must be registered with a

practice and patients can choose between them. On out-of-area rules:

• Patients will no longer be able to access urgent primary care offered by

contractors or sub-contractors in other county council area.

• These digital health service providers may need to apply for establishment in

all county council areas.

• These providers would need to offer in-person care, either themselves or by

sub-contractors.

• But, these same companies may also be used as digital care sub-contractors

by established / ‘traditional’ primary care providers to enhance their in- person appointments with video ones.

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Denmark

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Denmark

Many similarities to the UK:

• Universal coverage
• Free and equal / equitable access
• GP as “gatekeeper”

! Denmark has capitation for hospitals; any underspent is reinvested by the provider High ICT-maturity

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Email consultations

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Digital General Practice via an App

• Developed by the Danish BMA equivalent and the Ministry of Health and

Elderly

• App available since Jan 2019
• 3 weeks: 25k downloads, in 6 months: 100k unique users
• Not all practice IT systems support the app

Gives patients:

• Renew prescriptions, access to coded record, imms, children's

vaccinations, notifications from practice, record of referrals and of doctor's appointments

• e-consultations: asychronous messaging
• From 2020, first wave of clinics to be able to book face to face appts via

the My Doctor app.

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Digital General Practice via an App

For staff, the online consultations / digital platform allows:

• Fast patient overview
• “Intelligent” inbox
• Communication with local nursing teams.

Who pays?

• asynchronous consultations, national agreement to pay per episode.

22

Australia

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Lessons from Australia:

• Success in rolling out telehealth for remote + rural, but explicit payment

via fee-for-service.

• No default expansion of any success into wider outpatient care.

In general practice:

• General practice tends to be small units: anyone can open a practice,

and the GPs pay “rent”. Small margins.

• Two-tier general practice: for long term care and very easy “walk-in”

access for episodic care. Fee for service.

• No lack of access or convenience of face to face GP.
• No concept of registration, or expectation that a patient record will be

available.

• Patients therefore have not been attracted to digital PC, despite efforts

by a couple of large General Practice companies.

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New Zealand

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Lessons from New Zealand:

• Even more similar to England in terms of model inc administration,

commissioning functions, organisation of primary care.

• No major digital patient-facing functions by all PC / for all patients.

(apart from a major programme for telephone based advice)

• Bottom-up prioritisation of telehealth in 2 geographies where GP-at-

scale models have existed for a while.

• PC leaders have made clear: practices need ministry-led funding

and policy, to set up and deliver.

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USA

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US healthcare

• For-profit, non-universal PHI system vs the (non-) profit universal systems

(SHI or single-payer)

• Total $ disproportionally spent on healthcare for a proportion of population

based on multiple sources of private financing (insurance coverage / OOP) and not on need alone.

• more and better care for those that can afford it,
• the rest get sufficient coverage based on their budget,
• and some get “none” (stabilised and treated in ER, unfunded mandate)
• 15.5 % Americans lacked coverage for a core set of services than residents
• f all other OECD countries (-1) had
• 25% of American adults say they or a family member has put off treatment

for a serious medical condition because of cost

• More than 13% of American adults report knowing of at least one friend or

family member in the past five years who died after not receiving needed medical treatment because they were unable to pay for it.

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Health insurance in the United States

• 907 health insurance companies
• 60% of Americans are covered through an employer-

sponsored program, while about 9% purchase health insurance directly. Initially all-private, increasingly complex public/private mix

• Plurality of payers / insurers / health plans, providers / delivery

parties.

• Supplementary and complementary payers and deliverers.
• Major difference in State funding on medicare / medicaid.
• An estimated $2.1 billion is spent annually across the

healthcare system chasing and maintaining provider data.

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Primordial soup, but a v networked one

• About half of population receive their healthcare through an HMO or

some other managed care organisation. But also more integrated “health systems” than we have:

• Integrated delivery systems and integrated delivery networks
• Some have an HMO component, while others are a network of

physicians only, or of physicians and hospitals.

• The goal is to serve as a self-contained healthcare ecosystem,

coordinate delivery of care (and manage population health).

• Provider systems are starting new health plans, acquiring existing

health insurers, evolving from an existing ACO into a licensed health insurance company, JV with established health insurers.

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Integration across providers and payers

• Horizontal integration: scale
• Vertical integration
• Integration between providers: hospitals and PC
• Integration between some providers and payers
• Sometimes integration across payer – hospital care – primary care

BUT

• “population” = those that are in the plan, not the true population.

Evidence of positive impact of this:

• EHR within and across orgs
• eConsults between GPs and specialists

Main requirement for better use of digital: health system integration Unified health system like KP or even: UCSF, UCLA, VA, USC, CS

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Adding to the mix: telehealth / tele-primary care providers: synergy?

• I observed a lot of patient-facing digital inc concierge medicine

and direct-to-consumer primary care

• Some start from DtC and move upstream, some the opposite.

DtC has struggled to take off. Why do we bother with PC?

• With HI: insurer would rather treat you cheaply and not at

surgical intervention or LTC treatment.

• With PHI: as above, but also applies to employer.

Why digital PC:

• As above, AND cheaper for insurer to pay provider for delivery,

cheaper to access for patient as lower co-pay, and employer doesn’t lose you for half a day.

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Continued

How to drive utilisation?

• Anthem has decreased the copay for these visits to $5,

compared to a $25 to $35 copay if a member visits face to face their primary care doctor.

• An Anthem HealthCore study of claims analysis for utilization of

acute non-urgent care, found telehealth saved 6% in costs by diverting members who would otherwise have gone to the emergency room.

• Blue Cross Blue Shield of South Carolina: "This isn't a 'build it

and they will come' kinda of thing" "You really need to develop strategies to drive utilization.“

• They set a policy around telemedicine in order to boost care

in rural areas.

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Continued

VA Video Connect platform

• To start: VA had more than 1.3 million video telehealth encounters with

more than 490,000 Veterans in 2018.

• In 2019: pilot video consultations in Walmart rooms, in rural areas

Synergy example: partnership between Anthem, American Well, and Samsung

• American Well's telehealth service available to Anthem members with

Galaxy phones, via the Samsung Health app

• Aiming to become a ‘one-stop-shop’ platform for consumers to track their

health, share data, and communicate with healthcare professionals. Doctor on Demand in 2019 made a deal with Humana to sell what it calls the first "virtual only" plan design, which involves assigning primary care doctors upon sign-up based on a set of questions from the worker.

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I have not seen a health system that has answers to all these (and does it matter?):

• Who are the right patients to see via video?
• To get to book these appointments? How many result in

additional face to face visits?

• How to risk stratify via the triage stage? Prioritise?
• Supply-induced demand: does it hold truth for primary care more

than e.g. surgery?

• Digital skills divide
• Impact on clinicians (burnout and decision fatigue major issue in

US

• What is really needed: capacity, capability and willingness to

prioritise, consider, act

• Who pays for the tech, its implementation, and activity?

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Take home messages

What has worked:

• integration between providers, especially: hospital and primary care,
• capital and incentivisation by fee for service
• its allocation based on drivers such as:
• increased access via digital,
• convenience and 2ndary non-healthcare benefits that will drive uptake

(video consultations without leaving work / home) and

• on earlier action and prevention (PHI and SHI key drivers).

What hasn’t worked:

• Where necessary, NOT incentivising uptake by providers, or paying for tech

and implementation.

• Alternative routes to access to primary care; harder to replace something

that works.

• Build it and they will come.

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Thank you Dimitri Varsamis PhD

Senior Policy Lead, General Practice Strategy and Contracts Primary Care Strategy and NHS Contracts Group, NHS England https://www.england.nhs.uk/gp/gpfv/investment/gp-contract/ Made possible with funding from the Winston Churchill Memorial Trust, and represents the views of the author only, not of NHS England or the Trust. Hear more from me on: HIMSS SoCal podcast https://himsssocalpodcast.wordpress.com/2019/11/14/episode-27-developing

• digital-first-models-of-primary-care-ft-dimitri-varsamis/

Dr Ed Turnham

Clinic Lead for GP Online Consultations at Norfolk and Waveney STP and CCIO at Arden & GEM CSU

“Digital-First General Practice using Online Consultations in Norfolk and Waveney.”

#Convenzi s

Digital-First Primary Care: using FootFall for Norfolk & Waveney CCGs

Dr Ed Turnham

Clinical Lead for GP Online Consultations at Norfolk and Waveney STP CCIO for Norfolk and Waveney at Arden & GEM CSU

Bolt-on Online Consultations to practice website

September 2018 – possible approach 1

0.2% of consultations (Edwards et al., 2018) Disagreement about what it should be used for (Banks et al., 2018) Seen as a short-cut to getting an appointment Extra work for GPs

Online request Admin triage GP triage Admin resolve Send to other team Phone request

September 2018 – possible approach Digital Triage

Phone Online message Face-to- face

AskMyGP – encounter resolution mode

Requested by patient How practice resolved

Reproduced with consent of

AskMyGP – Digital Triage

Reproduced with consent of

AskMyGP – Digital Triage – key numbers

Reproduced with consent of

Demand is stable over time at 8% of patients per week Average response time around 90 minutes 78% of patients say the new system is better

https://www.aclemedicalcentre.co.uk/

FootFall

FootFall

https://www.aclemedicalcentre.co.uk/

FootFall

Week Requests as a proportion of practice population 40 41 42 43 44 45 46 47 0% 1% 2% 3% 4% 5% 6% 7% 8%

Requests by source

Self Proxy Staff

Our early findings

• Get patients online
• Equity
• Rapid response. Keep the patients on board + updated
• Training, training, training
• Process change
• Avoid duplication of clinical work

Digital Triage - key ingredients for success

Digital Triage – not telephone triage

Requested by patient How practice resolved

Reproduced with consent of

Monday Tuesday Wednesday Thursday Friday 5 10 15 20 25 5.8 4.9 5.0 3.7 4.5 8.0 6.8 7.0 5.1 6.2 8.4 7.2 7.4 5.4 6.5

Encounters per clinical session, by mode of resolution

Messages Phone F2F

Demand predictor

Hours Monday Tuesday Wednesday Thursday Friday 3.0 2.5 2.0 1.5 1.0 0.5 0.0 0.2 0.2 0.2 0.1 0.2 0.8 0.7 0.7 0.5 0.6 2.0 1.7 1.7 1.3 1.5

Time taken per clinical session, by mode of resolution

Messages Phone F2F

Workload predictor

Hours Monday Tuesday Wednesday Thursday Friday 0.0 0.5 1.0 1.5 2.0 2.5 3.0 0.2 0.2 0.2 0.1 0.2 0.8 0.7 0.7 0.5 0.6 1.5 1.6 1.6 1.3 1.5 0.6 0.2

Time taken per clinical session, by mode of resolution

Messages Phone Same day F2F Prebookable F2F

Workload smoothing

• Here’s what I’m going to say - see if you can think of any ways to illustrate it…
• Two extremes of approaches are possible within Digital Triage:
• 1) Assign the first request of the day to Dr A, the second to Dr B, and so on. Workload will be fair between doctors, but there is no continuity of

care for patients.

• 2) Assign each request to the doctor who knows the patient best, or the doctor whom the patient requests. This is good for continuity, but the

popular doctors will get more work than other doctors. When a doctor is away for a day or more, they may come back to a huge backlog of work.

• The solution: identify the 10-20% of patients who are most complex, and therefore are most in need of continuity (i.e. use simple population

segmentation). Focus on getting them seen by the doctor who knows them best. The remaining patients can be dealt with by any doctor. This allows the practice to spread workload evenly while maintaining continuity when it is important.

Continuity of care with Digital Triage

Assign the first request of the day to Dr A, the second to Dr B, and so on. Workload will be fair between doctors, but there is no continuity of care for patients. Assign each request to the doctor who knows the patient best, or the doctor whom the patient requests. This is good for continuity, but the popular doctors will get more work than

• ther doctors. When a

doctor is away for a day or more, they may come back to a huge backlog of work.

The solution:

§ Identify the 10-20% of patients who are most complex, and therefore are most in need of continuity (i.e. use simple population segmentation). § Focus on getting them seen by the doctor who knows them best. § The remaining patients can be dealt with by any doctor. § This allows the practice to spread workload evenly while maintaining continuity when it is important.

PATIENT AND DOCTOR BENEFITS SCALE

Next steps

Verifying patient’s identity Integrating into clinical system Online booking Video Tools to support practices: demand- supply calculators, population segmentation etc.

Online request Admin triage GP triage Admin resolve Send to other team Phone request

Where video fits in

Phone Online message Face-to- face Video

• https://bjgp.org/content/68/666/e1?ijkey=1b09bc08c14947fe84f792

9e78942948beaecedd&keytype2=tf_ipsecsha

• https://bmjopen.bmj.com/content/7/11/e016901?int_source=trend

md&int_medium=cpc&int_campaign=usage-042019

References

Thank you for listening! Any questions?

Dr Ed Turnham

Clinical Lead for GP Online Consultations at Norfolk and Waveney STP CCIO for Norfolk and Waveney at Arden & GEM CSU

Kieran Waterson

Head of Sales (UK) at iPlato

‘myGP – delivering digital-first primary care in 2020’

#Convenzi s

Delivering Digital First Primary Care Kieran Waterston

What’s the problem?

1. Demand growth for healthcare services is unsustainable 2. Healthcare is behind other sectors in adopting digital In an attempt to change this patients are being given the right to have digital first service

What does digital look like elsewhere?

Touch points in Primary Care

Appointment Booking & Cancellation Appointment Reminders Consultation Prescription Ordering Medical Record Access Queries Signposts Screening Advice

Patient Engagement Patient Intake & Care Navigation

Appointment Triage & Remote Consultation

Patient Insight (PHR) Book, Cancel & Request

Clinician Reception

25m patients

The myGP Platform

The myGP platform provides a streamlined interface solution between practices and patients

The myGP App

24/7 appointment booking & cancellation

Patients can manage their access to healthcare wherever they are via myGP. Links directly with INPS, TPP & EMIS

Appointment reminders

Patients receive appointment reminders as in-app messages. You can configure reminder settings in myGP platform. SMS costs removed automatically (typically 30%)

Improve uptake and awareness

• f health campaigns

Patients who are entitled to a free flu jab or NHS screening test can be invited to book via myGP. Hidden appointments just for eligible patients

Cervical Screening Programme in London Organisation NHS England (NHSE) and Public Health England (PHE) Goal Invite thousands of women to their due/overdue smear test appointments. Start August 2018 End August 2021 Description Female women across London surgeries will receive a letter from Capita and 2.5 weeks after a text reminder to encourage them to book the smear test appointment. If no appointment is booked, a second letter will be sent from Capita.

Consent No consent

Engagement Hub

Practice 2 Practice 3 Practice 1

London Cervical Screening Hub

From Station Road Medical Centre. Your cervical smear test is due. Please call 020 3345 7891

• r click on this link

to download our app to book on your phone.

Patient Experience

97% of practices in London signed up to the project 384,112 women were invited for screening from consenting practices Mobile phone numbers were extracted for 88% of these women For women who received a text reminder, uptake at 18 weeks was higher by: 4.8% in all age groups 4.8% in women aged 25 to 49 5.9% in women aged 50 to 64 The average time between invitation and screening: 54 days for women who received an invitation letter and a text reminder and 71 days for women who received an invitation letter only

Results

myGP Patient Surveys (FFT)

Feedback is automatically shared with you so you can make informed improvements to your services.

Medication Reminders

Patients can set up daily, weekly or monthly reminders for all of their medications. Push notifications are sent when it is time to take the medication. Adherence tracking helps patients to take control over their condition.

Repeat Prescriptions & Medical Record Access

• EMIS- Already Released
• TPP- Already Released
• INPS- Under Development
• 4504 practices in England have myGP

users (Jan 2020)

Directions to the nearest pharmacy

Patient's may be able to get their queries resolved at a pharmacy via a minor ailment scheme

Add Dependants

Patients can book and cancel appointments for their children, family and dependants. 273,000 dependants have been added (Jan 2020)

Mary Smith Jane Smith Alex Smith

Patient self-care tracking

Patients can record and monitor their blood pressure and weight on myGP. This module is for patient use only and helps with long-term condition management. Almost 100,000 patients are doing this (Jan 2020)

Remote Monitoring

Remote Monitoring

Self-monitoring is clinically proven to improve patient health outcomes. Request patients to capture biophysical data such as blood pressure or weight. Upon request, a temporary monitoring module will appear in the app.

Clinicians view in Platform

preGP

Patient Appointment Booking Data capture Intelligent Care Navigation Remote consultation

preGP remoteGP

Care Navigation- preGP

Intelligent care navigation

When booking an appointment, patients are signposted to alternative pathways depending on appointment reason, e.g. pharmacy. Automated, clinically safe sign-posting. Proven to successfully reduce appointment demand by 20%.

preGP signposting

preGP signposting

• Patient list of 6179
• 29% active myGP app users
• Over 1000 appointments listed on myGP across various slot

types

• 1849 appointment reminders sent via myGP or SMS
• 27 cancellations (£810)
• 10% reduction in calls to the surgery
• One day of administration time saved
• preGP + remote consultation diversion rate of 25% away

from F2F appointment (£3,330 cost savings)

• Total cost savings: £4,140

Case Study

Remote Consultation

Appointment Triage- All online appointments visible on one screen

Communicate with patient via Chat

Remote Consultation

Decrease unnecessary face to face appointments by resolving requests remotely. Check appointment details and make informed decisions about triaging. Organise a video or telephone consultation on myGP. Send in-app messages to request additional information.

The ability to start a Video call with just one click

Simply click here to initiate Video

During the call you can control: Sound Microphone Camera End Call

Video Call Controls

Video Calls – Patient Experience

Is the myGP active at the practice? Yes Registration with just mobile number and DOB Book & Cancel Appointments Signposting Video Consult Remote Monitoring If they add their Online credentials Prescription Ordering Medical Record Access No Patient has to have their online credentials Book & Cancel Appointments Prescription Ordering Medical Record Access

Easy Access

Question Time

Please email any questions to myGPSupport@iplato.net.

QUESTION TIME

kieran.waterston@iplato.com

Dr Pritesh Mistry

Clinic Innovation and Research at the Royal College of General Practitioners

“Primary care innovation: from frontline ingenuity to AI”

#Convenzi s

Primary Care Innovation: from frontline ingenuity to AI

Dr Pritesh Mistry – Head of Innovation Royal College of GPs

Declaration of interest

I do not have a conflict of interest (financial, commercial, personal, professional, advisory, research-linked or other) relating to this event.

Who am I?

Who am I?

RCGP Innovation

Not just tech! Supporting ethical innovation

• Co-development,
• Demonstrable evidenced improvements preferably outcomes

based

• Respects privacy
• Honesty and transparency
• Inclusive
• Matches values of the users and professionals
• Sustainability

Leaps and iterations not destabilising

RCGP Innovation

• System level
• Person centred care
• Team based care delivery
• Network based care model
• Digital systems
• Continuity of care
• Genomic services
• Digital Therapeutics

Grassroots innovation: what's happening on the frontline?

• Open source
• Process, systems and COTS
• GPs, Practice Managers, Nurses and Patients!
• Peer group based spread and adoption

Entrepreneurial innovation: Mentoring innovative GPs

• GP entrepreneurs
• Commercial products/services

addressing unmet needs

• Mentoring
• Non-clinical skills

Entrepreneurial innovation: Mentoring innovative GPs

• Dr Campbell Murdoch (Gro Health) a digital health platform

addressing type 2 diabetes burden

• Dr Monal Wadhera (LiveSmart), digital health tool

supporting prevention

• Dr Farhan Amin (Founder Concept Health), VR+ML making

existing resources go further

• Dr Rakeeb Chowdhury: (Founder BookYourGP), automating

processes saving time and money

• Dr Nicholas Harvey (Founder Digitalis CPD), improving how

we learn

Entrepreneurial innovation: Mentoring innovative GPs

• Dr Abdullah Albeyatti (Medicalchain) interoperability of health

record systems

• Dr Chris Castle (GPEP), empowering self care and rehabilitation for

MSK conditions

• Dr Stephen Katabe (Tekihealth), rural telemedicine addressing GP

workload and recruitment

• Dr Tom Adler: (Peak Medtek), rural tech preventing night-time falls

in frail elderly

• Dr Catherine Millington-Sanders (Difficult Conversations), improving

how we train professionals for digital consultations

Entrepreneurial innovation: Pilot sites

• Medway Innovation Hub – 48 practices and 300k patients, co-

founded with CCG to accelerate innovation in Medway

• One Care Ltd – 80 practices and 1 million patients, support

practices in key areas: service redesign, workforce, workload, digital and analytics

• South Westminster Primary Care Network – mid-London network of

10 practices with broad demographics and challenges

• Sunderland GP Alliance – 42 practices, 250k patients, not-for-profit
• rganisation, collaborative working for benefit of GPs and patients
• AT Medics – 42 practices, 270k patients, London’s largest primary

care provider

Entrepreneurial innovation: Year 1 impact

£3M VC £400k grants

1 NHS contract

Peer support confidence learning credibility networks

Clinical safety Evidence generation

3 new innovations

Professional Development

Digital nurses

• South Staffs
• Upskilling GPNs to be digital nurse champions (8 wk)
• Substantially increase utilisation of technology
• Pragmatic and realistic approach using familiar tools (Facebook, WhatsApp,

etc)

• Empower the individual enabling greater self-care
• Increase GPN confidence -> support colleagues -> increase colleague

confidence -> change in culture

• Small but steady & manageable changes

RCGP Innovation

• Emerging areas
• Establish a foundation of understanding
• White papers and round table discussions
• Artificial Intelligence (published)
• Internet of things (in process)

Trust & bias

• Multi-layered
• Algorithms
• Data
• Corporations

Creating tensions: Replacing or co-existing

Artificial Intelligence

AI – Machine Learning & vision

Adaptive algorithms Black box systems Trust, bias, explainability, regulation How much data is enough? Quality and biases? Remote ECG system, (symptom checkers), radiology & ophthalmology Translate the secondary care advances to support primary care – dermatology, retinopathy New data sources: E-stethoscope, ultrasound

AI – Natural Language Processing & Speech

Voice to text, text to voice and querying free text Alexa used to access health information Consultation support Chatbots to provide trusted information Privacy, accuracy, terminology, error correction Free text section of EHR, consultation, asynchronous support

Planning, scheduling, optimisation & Robotics

Rotas, admin automation, workflow optimization Robotic and remote surgery Nascent field of AI Multi-disciplinary teams, complex patients, insufficient workforce numbers, automation Improving and deskilling surgical interventions Minor surgery

What are the concerns?

• Clinical autonomy and clinical judgment
• Unclear bias, risk and liabilities
• Widening health inequalities
• Overdiagnosis and overmedicalization
• Conflict between black box systems and
• Shared decision making
• Evidence
• Risk

Unmet need

• Workforce
• Insufficient numbers – making resources go further without adding burden
• Workload
• High workload – improving safety, wellbeing (patient and clinician), automation
• Complex patients
• Multiple long term conditions - Older more complex patients

Discussions and collaborations…

• pritesh.mistry@rcgp.org.uk
• Twitter: @mustbemistry