Three things in life are certain – death, taxes, and increasing pressure on general practice.

Paul Bensley, MD of cloud healthtech provider X-on, says their experience suggests that meeting current communication demands means something different to practices.

The recent NHS Long Term Plan looked to address at least one of those certainties – the demands faced by GPs across England. One of its central ideas was a move to ‘digital first’ primary care – in part, encouraging patients to Skype their GP, as some have described it.

With smartphone usage on the rise, and as most people have some form of Internet connection, many patients are beginning to expect ways to connect with their GP that match their current communication preferences.

Yet ‘digital first’ primary care is more than just Skype consultations. Our experience suggests that meeting current communication demands means something different to practices.

It means being able to send out messages when appointments are no longer available. They are having to work out how best to manage hub operations so that other organisations can help them cope with increasing demand. Now, many are faced with the mandate to axe the fax.

The GP Partnership Review stated that technology should enable GP partners to confidently address workload and safe working capacity issues, while continuing to support the continued delivery of high quality, personalised, holistic care. The current focus on video consultations is in danger of overshadowing more pressing needs facing primary care services.

Sound infrastructure is required, and telephony and communications services need to be recognised as the platform that can deliver digital first primary care.

Helping cope with immediate pressures on general practice

Such infrastructure can enable smarter working practices of the future, as well as help with the pressures of day-to-day operations.

Automated messages can allow patients to manage their own appointments, reducing the burden on admin staff. Multiple organisations can use a single system to handle calls, supporting extended access and out of hours operations. It can even replace the endangered fax machine, providing a secure method of communication that is simple to implement and use.

The technology can also provide the foundation for video consultation; although its relative lack of maturity in this market can make this a challenging proposition. Clinical system integration, for example, takes a lot of effort.

In its drive to be innovative, the LTP put forward a narrative that was heavily driven by the GP At Hand/Babylon video consultation trials, and high-profile lobbying. However early results have been called into question, and many GPs appear sceptical.

And whilst early adopters will welcome new forms of consultation such as video, we’re finding that such new approaches are yet to be top of mind for practices. Telephone triage is more widely recognised, as it is increasingly helping many practices provide more efficient means of communicating with patients.

In addition, the LTP’s digital first vision represents a big push away from the corner shop model, where the patient-GP relationship is a highly significant factor, directly to the Amazon one, where convenience matters most. The GP Partnership Review noted that the family doctor relationship is something that should be preserved where possible, and it will be interesting to see how this evolves as emerging forms of consultation grow.

So the LTP is right to promote a digital first approach. But digital innovation has to deliver meaningful impact at the healthcare frontline if it is to succeed.

A nation that still hangs on the telephone

Where the LTP focuses on Skype-like technology, CCGs and GPs across the country say that the telephone is the readily accessible digital technology of choice for both practices and patients.

Almost 8 out of ten respondents to the latest GP Patient Survey used the phone to book an appointment with their GP. Almost one in ten conducted their appointment over the phone. If their GP practice was closed, three in five contacted an NHS service by phone.

Another consideration is that the NHS was built on equitability of access. Over one in four of us do not use a smartphone, according to Ofcom data. However almost 90% use a mobile phone. The telephone remains ubiquitous. It is the bedrock of person-centred care, delivered by family doctors across the country.

A digital first approach should ensure that services meet the needs of all. The NHS can benefit from giving people multiple ways to access healthcare services in ways people want. However it needs to start from firm foundations, and build innovations in a culture of multiple demands.

The infrastructure underpinning digital telephony can also deliver numerous administrative and financial benefits that can be realised now. We have seen practices reduce the number of DNAs, cut administrative workload and deliver more holistic, personalised care by using the advanced telephony available through our Surgery Connect technology. Features such as unlimited phone lines, automated telephone booking, clinical system integration, and call recording, help patients and professionals alike.

Digitising telephony makes it simpler to report on phone-answering performance across multiple sites. This helps the NHS use data to identify what good looks like, and address system-wide standards that can provide a better experience for practices and patients alike.

Digital first things first

Telephony provides the infrastructure to meet immediate demands, whilst also providing a platform for LTP ambitions such as video consultation, or innovations such as using telephone reminders to assist with medication adherence.

Joined-up telephony is providing many of our customers, such as GPs in Worcestershire, with the infrastructure to meet existing demands, whilst also provide ways to support new models of more integrated, community-based care. It also helps them avoid the imminent headache of having to deal with the ISDN switch-off, with digital phone services becoming the norm from 2025.

The Primary Care Networks trailed in the LTP need to consider how VOIP telephony can support practices work across a community of care, and help them be more sustainable. Advanced telephony can enable GP partners to address workload and capacity issues, whilst continuing to support continuity of high quality, personalised, holistic care.

As certain as death and taxes, pressures will only increase on primary care. The latest breed of telephone systems can help address those pressures, and support primary care as it evolves to address the needs of a growing nation of video-enabled, smartphone-wielding healthcare consumers and providers.

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