Lack of ‘robust’ digital systems is pilling pressure on GPs
- 24 June 2020
A lack of robust digital systems and sustainable plans is leading to extra work for GPs, a British Medical Association (BMA) survey has revealed.
Due to reduced numbers of patients attending hospital because of the coronavirus pandemic, family doctors across the country are now expected to perform blood tests for hospital outpatients, prescribe medication that would normally be given in secondary care, and complete tests before making a possible cancer referral, which could lead to delays in treatment.
This is often due to a lack of digital solutions to enable hospital doctors to do this, as well as a lack of planning for alternatives in the community, the BMA found.
In fact, half of the 7,497 doctors who responded to the survey said that they were having to now provide care that would normally be delivered by secondary care colleagues.
And a further 81% said they had been asked to carry out new investigations and manage ongoing care, which would also usually be done in hospitals, further adding to GPs’ growing workload.
This additional workload is not only because the NHS is currently operating in the middle of global pandemic, but also, and fundamentally, because of a lack of robust IT systems and digital solutions to help secondary care colleagues to complete necessary tasks, leading to work transferred to GPs without sustainable services being put in place, according to the BMA.
At the start of the Covid-19 pandemic, GP practices across the country were advised to embrace digital tools and assess patients online or via telephone and video appointments to mitigate the potential spread of coronavirus.
Digital Health News asked a number of providers how patient’s had used digital services during the pandemic and found telephone and text was preferred over video as it was more convenient.
Dr Richard Vautrey, chair of the BMA’s general practitioners committee, said: “The NHS was always going to see a drastic increase in patient demand as Covid-19 arrived in the UK, but this crisis has truly shone a light on the lack of robust IT systems across the health service and the tsunami of extra work increasingly placed on GPs as a result.
“This needs rapid action to deliver long-term solutions to improve the interface between secondary and primary care, and make sure we have the digital infrastructure in place to stop unnecessary prescribing, duplication of workload and extending patient pathways.
“The longer this goes on, the more at risk we are of losing talented healthcare professionals which is why we desperately need to reduce the burden of unnecessary bureaucracy and regulation such as CQC inspections, put in place better digital systems, and provide general practice with the funding needed to deliver new services.”
4 Comments
Hi Mary
Thank you for that RCGP Guidance. I’ve had a look and noticed it says “NHS Connecting for Health (NHS CFH) has now moved away from a “replace all” strategy for electronic patient records to a “connect all” strategy, with a plurality of inter-operable systems in place.” Again, there is a false assumption that interoperability somehow makes multiple EPR systems into a single integrated one, like Lego bricks (which were designed to work together). Or that picking out a few data items from various systems to share on a repository equals digitisation: sharing EPR data is not the same as sharing EPR functionality and the latter is what is needed for integrated care (in addition to data). Shared care record systems do not deliver the EPR functionality that collaborative care teams and patients need to manage care across settings. There are also patient safety risks to bringing medication and allergy data from different systems. Who curates it? Who is legally responsible for a clinical decision that causes an adverse drug event as a result of erroneous shared care record drugs data drawn from multiple systems and settings? I also do take your point about the poor state of much secondary care IT in the UK, there is a huge variability there, and certainly, GP computing is more uniformly robust in the UK. I have analysed each NHS Trust’s EPR system and found that only 61% of acute hospitals in England have an integrated EPR, whereas I imagine that number to be in the high 90s for primary care GP practices. Can we continue this conversation via LinkedIn please? Best wishes, David
The right long-term solution is a single integrated EPR operating across settings (primary, community, acute, mental health and social care) for each health economy, STP or Integrated Care System. Such EPR systems do exist (across most care settings) in the UK, but are running in other countries such as Canada, Norway and Finland. The vast majority of US clinicians today use a single integrated EPR to care for patients across these care settings.
Shared care records, with view only repositories of very limited data (less than 1% of an EPR’s data elements), may help tactically in the meantime but suffer from inherent poor data quality due to underlying best of breed interfacing weaknesses.
KLAS and US CIOs confirm that the US left best of breed EPR approaches behind 10 years ago. They recognised then that truly integrated care needs truly integrated EPR systems. By running single integrated EPRs across 44 STP/ICSs, we should end up with fewer larger EPRs rather than our current chaotic landscape of hundreds (thousands) of disparate EPRs that were not designed to work together (and cannot be retrospectively forced to interoperate via so-called interoperability standards). We can still have a healthy number of EPR suppliers, but they will be delivering cross-setting systems.
Interop standards will be useful in the future, in helping the 44 ICS’s to exchange data at the boundaries. But “Interoperability standards” are not a magic glue that will turn existing disparate EPRs into single integrated ones. From a workforce and architecture point of view, best of breed exposes hospitals to too many single points of failure where single individuals monopolise knowledge of how a system works. This translates into clinical, technical and financial risk.
When are we going to have a proper dialogue (not via this Leave Reply in the Comment box manner) about the pros and cons of best of breed v integrated EPRs? The NHS has been drifting on this question for several years and £ms are being invested in both when they can’t really both be right.
There is no evidence that integrated EPRs can only be afforded by larger, financially healthier Trusts. There is evidence that NHS Trusts of all sizes have integrated EPRs.
The NPfIT/CfH solution – in East of England & North East – *was* a single shared record: Lorenzo Regional.
It didn’t arrive – & had it been successful, it would only have covered the Accenture LSPs.
It did, however, highlight the problems of single records of prime entry, discussed in detail in the Shared Record Professional Guidance report from the RCGP – sadly no longer available but summarised in Chapter 5 of the Good Practice Guidelines for general practice electronic patient records v 4 https://www.gov.uk/government/publications/the-good-practice-guidelines-for-gp-electronic-patient-records-version-4-2011
Shared records – or access for primary care to secondary care systems – would help by making information potentially available where needed – but wouldn’t actually solve the problems confronting the GPs complaining about the chaotic state of secondary care IT: the problem is a process one: work for which secondary care is responsible & funded is being dumped on GPs… with the added problem, probably, of lack of access to the means of doing a good deal of that work e.g. imaging…
IMG Information Management Group) promised interoperability – in 1992.
NPfIT (National Program for IT) & CfH (Connecting for Health) promised complete digitisation of the NHS – in 2002.
NHS Digital/X/England has the same plans.
Either the problem – & the change processes needed to introduce IT into any setting (IT disasters are not limited to the NHS: remember TSB?) – have been underestimated, or not addressed, or possibly – probably? – not even considered.
The default in the NHS is always to dump additional workload on general practice, preferably without any transfer of resources: even the funding proclaimed to allow GPs to fund measures needed to keep operating such as staff/locum replacements for people having to shield, safe isolate – or off sick with COVID-19 – , PPE and surgery adaptations has not been delivered: going by past experience, will it ever be delivered?
There are islets of functioning IT in secondary care: but why bother joining it up when problems can always be passed to general practice & other primary care sectors?
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