Dr Eric Kelly looks at negative perceptions of telehealth and shares his experience of deploying a GP led telehealth programme that has reduced admissions and improved patient outcomes
Amid warnings of a £30bn NHS funding gap by 2020, and as the number of people living with long term conditions rises, telehealthcare is seen as solution for streamlining and improving services − one that enables patients to manage their own conditions safely and securely.
‘Some believe the mooted benefits of telehealth are over-hyped’
While many practitioners support this view, for some GPs the adoption of telehealth is a hugely contentious issue.
Some believe the mooted benefits of telehealth − efficiency and financial savings − are over-hyped; for those who are opposed to introducing new care pathways, telehealth is an experiment that serves only to increase GPs’ workload.
Do what’s right, not what’s popular
I can sympathise with those who are opposed to using telehealth as a new way of treating patients; GPs across the UK are struggling with the secondary to primary care workload shift, coping with long working days and the increasing administrative burden. From their point of view, where is the merit in investing in a new care pathway that could exacerbate the strain on resources, and which offers no guarantee of immediate benefits?
‘Patients’ visits to the surgery are reduced, yet we are able to monitor their conditions more closely’
Working as a GP in Bentley, I share a medium-sized practice with four other doctors. Together, we believe telehealth can offer an efficient, sustainable care pathway for the management of patients with long-term conditions.
We began deploying telehealth nearly three years ago and Bentley Surgery is currently the only practice (out of 44) in the region to offer the service.
Other practices rejected the model; the Local Medical Committee secretary branded telehealth a waste of money, and without financial backing many GPs felt that offering such a service would be outside of their contract.
It would have been very easy to fall in line with popular consensus, but as a practice we believe in doing what is right, rather than what is popular.
Long term challenges
A former mining village, Bentley is just two miles north of Doncaster which, with a population of 302,000, ranks as one of the UK’s worst areas for high mortality rates and increased numbers of patients living with long term conditions. There is a prevalence of COPD, diabetes and heart failure, and widespread obesity poses a further concern.
‘Even though the use of telehealth in Bentley is on a relatively small scale, we have seen a notable reduction in hospital admissions for certain patients’
We wanted to reassess the way we were caring for patients in the area who were living with long term conditions. My colleagues and I had attended presentations on telehealth and were aware of its use among community cardiac nurses.
Initially, we offered telehealth to heart failure patients to monitor their conditions post-discharge. The service was found to be particularly helpful with the titration of heart failure medication; as patient data is carefully monitored, we can build a much clearer overall picture of a patient’s condition. We are immediately alerted to any sudden changes, allowing us to alter medication doses accordingly, without the patient having to endure prolonged symptoms and associated distress.
The ability to keep an eye on their overall condition also helps to give a better indication of whether or not a patient’s condition is stabilising, at which point we can look at withdrawing treatment. Patients’ visits to the surgery are reduced, yet we are able to monitor their conditions more closely.
Setting routines
Interestingly, we have also found that telehealth treatment plays a key role in establishing routine for patients suffering from conditions such diabetes.
‘Following deployment at Bentley Surgery, I’ve found that telehealth actually decreases my workload’
As with surgeries across the country, Bentley has a number of patients who often struggle with remembering to take their medication on time. By using telehealth, these patients quickly adapt to having to take blood pressure and other measurements at certain times each day, with the service acting as a prompt for them to take their medication too.
Telehealth is also particularly helpful for patients who live on their own and suffer with anxiety over their condition. It really does offer a “comfort blanket”, as patients find it reassuring to know their health is being monitored. They are also able to gain a much better understanding of their condition, which means they regain control.
Even though the use of telehealth in Bentley is on a relatively small scale, we have seen a notable reduction in hospital admissions for certain patients. We also receive fewer calls to the surgery from patients with long-term conditions. This is taking away some of the strain on our resources, while improving individuals’ quality of life.
Allaying cost concerns
Two of the key arguments from GPs against the adoption of telehealth focus on the issues of a potential increase in workload and costs.
‘Based on the successful use of telehealth in Bentley, I would certainly encourage other GPs to explore the service’
Following deployment at Bentley Surgery, I’ve found that telehealth actually decreases my workload; patients are able to better manage their own conditions, meaning they don’t need to visit the surgery as often. As for costs, I think GPs need to look beyond the figures of initial investment towards the long term implications.
Take hospital admissions, for example. Under traditional treatment you might have a case where a patient with COPD is admitted up to five times in a year, costing the NHS approximately £15,000. By investing in telehealth, these admissions could be reduced, and perhaps eliminated – significantly lowering the overall care costs.
Also, with the arrival of a cash incentive with direct enhance service (DES) for remote care monitoring, there will be financial gains for deploying telehealth. DES is available to any participating GP practices in the 2013-14 financial year and offers £0.21 per registered patient, which represents a payment of approximately £1,478 to an average-sized GP practice.
Questions over evidence
Some GPs have questioned the “lack of evidence” to support telehealth as a viable model of care, but there have been some very successful programmes. In areas such as Gloucestershire and Birmingham, where telehealth and telecare from Tunstall has been used to support people with long term conditions, assisted living technology schemes have been particularly well received, with thousands of patients benefiting from improved care.
‘Telehealth is not for everyone − at Bentley, we make sure we look at a patient’s history and their personal circumstances’
Based on the successful use of telehealth in Bentley, I would certainly encourage other GPs to explore the service.
I believe the key to maximising the benefits of telehealth is making sure it is offered to the right patients. GPs need to be sensible about who they target. It would be easy to take a blanket approach and offer the service to all patients living with long term conditions, but this is unlikely to create a successful or sustainable programme.
Telehealth is not for everyone − at Bentley, we make sure we look at a patient’s history and their personal circumstances before making a decision as to whether or not the service is a suitable option.
Alone, telehealth is not a magic wand that can heal the condition of the NHS and it is not entirely unreasonable that GPs are sceptical of its value. However, in the long term, mainstreaming telehealth would address some of the woeful issues facing our health services.
Dr Eric Kelly is a GP based in South Yorkshire
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