Driving the future of digital primary care

All the time, we are seeing more funding provided to healthcare to drive digital innovations. The NHS England London Digital First Programme, for instance, will be funding automation grants of up to £65,000 and is encouraging all pilots/projects across London’s integrated care systems to apply.

Funding alone will not be enough for the NHS to thrive in the future, though. Primary care needs to rethink its role within the wider healthcare ecosystem, and redesign what it does. It has become clear that the future of digital primary care will be driven by three key pillars: accessibility, interoperability, and personalisation.

In terms of accessibility, we have seen a broader digital response to the consumerisation of health and care, with increased service user inclusion, service accessibility, and using telehealth for appointments, consultation, prescription refills, and mobile access of records.

Accessibility is being expanded further, to more regionally-led packaged services for discrete patient cohorts, with greater use of virtual hospital wards and remote monitoring, the leveraging of wearable 5G-connected devices – for those patients who need and want them.

Funding this change will be challenging. The commercial and cultural hurdles are just as big for integrated care boards. These boards may wish to unlock more primary care data to better manage distributed patient risk and service provision for preventive and personalised care across the health economy.

However, healthcare and local government institutions need more than just ease of data access to the primary care data. They need standards-based interoperability capabilities promised by a universal adoption of the latest editions of HL7 Fast Healthcare Interoperability Resources®, with widely-fed repositories and standardised reporting. The NHS will need to enforce these standards, along with the now pre-requisite process governance because today several industry stakeholders have still not understood or implemented adequate clinical safety compliance for the DCB0129 and DCB0160 clinical risk regulations.

Every service is responsible for a patient’s care, and so must be on par with acute and primary care funding and management

In the coming years, ICBs will need to decide how to help primary care fund change management and digital transformation that contribute the goals of the ICS, which will mean structural changes that fund both digital systems and primary care provision.

What’s needed, above all, is end-to-end process interoperability to automate care proactively and intelligently, in a way that leaves no gaps into which patients can fall.

For effective transparency, interoperability, and automation within digital primary care, multiple regional stakeholders across the ICBs will need to think in whole-system terms. To establish shared access and outcomes that span the patient, service users, and care professionals’ experiences. Every service is responsible for a patient’s care, and so must be on par with acute and primary care funding and management. We are seeing this starting to happen today with the creation of the ICBs.

There are also good examples of regional thinking, such as regional waiting list triaging, and discussions for regional virtual wards for ambulance service patients in transit. Elsewhere, AI is increasingly being used in numerous scenarios. From analysing patient generated data from wearable and medical devices, and the early diagnosis of Alzheimer’s disease using image recognition, to facial analysis for ADHD, stress, and pain management.

To scale such innovation and sustain digital transformation across healthcare we need to connect the operational systems and use the “exhaust data” generated by their workflows to teach machine learning and AI to ensure objective, timely and explainable decisions are made in the entire chain of care. All with the transparency required to ensure human oversight and processes avoid the all too prevalent bias present in AI’s machine learning data, algorithms, and the robotic process automation it can enable.

Looking ahead

Recently published insights indicated that “personalised, precision medicine” could be on the horizon in 10 years from now. While it may take more than a decade for wide adoption to occur, digital primary care can make a start with gender, age, and demographic-aligned diagnosis and care pathways with measurable, more effective medicines. The future may even witness GPs using augmented reality visual tools supplemented by artificial intelligence and rich clinical decision support systems to diagnose patients faster and more accurately.

By extension, they could then publish that diagnosis with a personalised care plan based on the patient’s epigenetics, lifestyle, and agreed compliance to their approved care circle and patient support groups.

These kinds of fundamental digital changes are all in the offing over the next decade. However, to make that happen, the sector must rethink and reset the role of primary care in the NHS with its funding, and redesign of what primary care means and does. That’s starting to happen today and so this positive vision is beginning to look more like a viable future reality.