Can digital self-management prevent over-treatment and support people when NHS services can’t?

Now, more than ever, the NHS needs people to self-manage where possible (preventing over-treatment) and provide support to people who can’t access services (preventing under-treatment).

Over-treatment

Common musculoskeletal injuries and conditions account for up to 18 per cent of GP appointments and cost the NHS £5bn per year. Approximately 20 per cent is over-treatment with a growing number of people waiting for treatment with no effective support. It is widely acknowledged that many musculoskeletal conditions can be managed with the correct self-management strategies, reducing over-treatment. The National Institute for Health and Care Excellence guidance, the NHS Long Term Plan, and the Department of Health all recommend self-management strategies, along with independent bodies such as The Health Foundation, National Voices, and the Arthritis and Musculoskeletal Alliance.

Under-treatment

One in three women will experience a pelvic floor disorder in their lifetime. This is a hidden condition that is commonly normalised and misunderstood. Women often report a lack of confidence to manage their pelvic floor symptoms, compounded by limited access to expert advice and support. This has a major impact on women’s lives that can be dramatically improved with early evidence-based support. Services aren’t currently able to meet the support standards set out by NICE.

Unlike many current self-management support strategies, digital technology provides a potential route to provide support at scale, but can this be achieved, and does it work?

getUBetter is an evidence-based, CE marked, digital self-management platform for all common MSK conditions and women’s pelvic health. We help integrated care systems to support self-management across their entire care pathway. It provides support 24 hours a day, 365 days a year, taking people through their recovery day by day and providing them with the knowledge, skills, and confidence to self-manage.

Support is provided through triage, advice, exercises, outcome measures, safety netting, and referral when necessary. We are working across 12 ICSs covering 12 million people and 1,800 GP practices. More than 45,000 patients have been supported delivering real-world benefits, some of which are listed below.

• 13 per cent reduction in first time GP appointments
• 15 per cent reduction in repeat GP appointments
• 50 per cent reduction in prescribed medication
• 20 per cent reduction in physiotherapy referrals
• 66 per cent reduction in Emergency Department visits

Like all digital transformation projects, the technology is only a fraction of the story and we have learnt valuable lessons about providing digital self-management support at scale.

Lessons learnt

• The digital service must take an evidence-based approach to the condition that is being supported including the physical, mental, societal, and behavioural impacts of the condition.
  
  
• The digital service must be co-produced with key stakeholders including patients, clinicians, and commissioners. If key stakeholder groups are not aligned or the service not seen as complementary to existing services, then it will fail.
  
  
• People need to feel in control and not like they are being “fobbed off”. This means that they should always have a route into traditional services if they want to and be able to control progression of support and exercises dependent on how they are feeling.
  
  
• The service must take a whole ICS and pathway approach and cover all common conditions so that both people and clinicians aren’t trying to work with multiple siloed apps. Support must be made available at the earliest possible interaction with the health system. Content and signposting must be localised to local ICS pathways.
  
  
• The digital service must be clinically safe with robust safety-netting so that people are directed and access services when needed.
  
  
• The service needs to support the full condition lifecycle including new, recurrent, long-term episodes and prevention and provide true self-management support, so people are only directed to services when necessary.
  
  
• Deployment and product development must tackle digital exclusion. This is best done through co-production with people with different physical, mental health, social, cultural, and learning needs of all ages to optimise access and minimise exclusion.

The NHS has talked about self-management for a long time, but it is now becoming a reality. No person should have to wait for local support for their MSK condition or pelvic health problem. It should be provided at the first opportunity, available 24 hours a day 365 days a year and be inseparable from the care people receive. 

If you are interested in finding out more, we are holding an MSK webinar with Somerset ICS on 19 January 2023 and a women’s pelvic health webinar with South West London ICS on 1 December 2022. Follow the links to sign up.