Another View: Of cracking the GP IT market

How can innovation flourish in the GP IT market? That is just one of many questions Dr Neil Paul tries to tackle in his latest column for Digital Health where he explores the players involved in introducing technology in primary care.

After my last column I was contacted by a person in a UK company who work alongside the NHS. They have a new idea/product that they think could help GPs/NHS. They appear to have money from their main contract so getting off the ground isn’t their problem.

Their problem is who to sell to, where it fits, and I think it’s worth discussing as it fits with problems other companies I have spoken to have.

This company has an app, though I suspect the real IP is the algorithms. The app takes a history direct from the patient and tries to diagnose their musculoskeletal (MSK) problem and then offers advice and self-treatment.

This isn’t really that innovative as there are quite a few apps like this aimed at small niche areas; mental health, paediatric illnesses etc but it could help.

The company’s blurb suggests they have evidence using it avoids needing GP appointments.

The information I saw wasn’t that clear on how robust this evidence was, but in its defence, it was early marketing.

But for the sake of this discussion let’s take it at face value that it does successfully diagnose some MSK problems and can therefore do without a GP in some cases.

Capitalising on innovation

Their question I guess is how to capitalise on this idea/product?

Initial thoughts appear to be to approach CCGs and see if they were interested as saving GP appointments sounds like a good thing and something a CCG might be interested in.

Personally, I don’t think this is going to work.

In some ways the easiest way to make money might be to sell to the public and charge once per download or per use.

I guess they could do some form of cross marketing deal, they could sell to insurance companies to try and reduce post injury costs or sell it to someone like one of the private online GP appointment providers.

If it takes off, they could be rich.

Knowing who to target

The company may have thought of all of this, but they feel they can help GPs, which is a great sentiment but here is the problem – Who buys it and on what model?

There are roughly 8000 GP practices but there are no procurement rules and most practices will buy stuff proven to work.

As a practice one of my questions is how much and is it a pay per use or an annual subscription model.

I can’t charge my patients to use it so it would have to be free for them to use.

If my surgery buys it, which really means I buy it, and makes it available, how do I limit it to my patient?

I don’t want to pay for people who aren’t my patients to use it or worse pay for those who wouldn’t have rung me and would have gone elsewhere.

I don’t want to be paying from my pocket to save 111 time and money. How do I target it at the people it will help not those it won’t?

On a per use basis I’ve no real idea what the yearly outlay might be, so I guess I’d prefer a fixed fee.

In fact, I’m not sure I’m going to pay anything unless I’m absolutely convinced its saving me lots of money.

Costs of implementation

Then there is the cost of implementing, which is often under thought out. Dealing with the complaints from people who don’t like it and again, and am I taking clinical responsibility for its actions?

What about the times it gives the wrong advice? What about the times it says they need to see a GP, but I disagree with it? Do I only pay if it saves me an appointment?

Is an app the wrong thing? Does it need to be a script that my receptionists can use as part of their care navigation? Or perhaps I should add it to my website?

But it might take a lot of time and effort to make people go to my website rather than ring in for specific issues only and we are in the crazy situation where people don’t use my website to book an appointment with me as the powers that be have taken that control from me.

We now have a plethora of apps that allow almost unfettered access to my appointment book which our receptionists usually try to triage and control. I can’t see any major company e.g. John Lewis letting multiple app companies control their experience of shopping at their store.

Is selling their algorithms to one of the current app providers an option? What if only one bought it we could be in a weird situation where one app triages appointments and another doesn’t. Which app do I recommend to my patients? Can I force them to use the one that reduces appointments with me?

Perhaps the algorithms need to be forced at a national level onto all app suppliers? But can you see this happening?

Who will buy?

Will a CCG buy it for their practices?

In my experience CCGs have no money and aren’t really that passionate about innovation in primary care IT. They struggle to deliver the core desktops and services and nationally mandated stuff.

I’d like to be wrong here, and to be fair, at year end, there are often pots of capital that need spending that CCGs have access to but these often don’t include the project management and ongoing support costs, so it can be difficult to get some projects up and running.

NHS England often has more pots of money to spend on new ideas and have been keen on reducing demand on primary care.

The NHS England primary care top ten tips to reduce workload programme was a brilliant idea. It funded a load of pre appointment triage.

I think a lot of money went into it certainly there was a framework of chosen suppliers.

Not really sure I know of any one locally doing anything with it for some of the reasons discussed above.

We all met; we all chose our preferred choice, but have they been implemented? Perhaps some have? I’ve heard very little evaluation of how successful it has been.

I could see a hospital trust having their own independent solution say providing access to out-patients. They appear to be big enough to do their own thing. Perhaps this is the solution.

Primary Care Networks (PCNs) or super practices who get big enough might start wielding enough power to not accept the standard offering.

Perhaps they might choose to have a custom-built appointment tool that serves their bespoke needs and only allows apps that they approve to give away appointments.

Perhaps they will be big enough that purchasing some tools saves enough appointments to be significant.

However, I’m not sure many of these exist at the moment with enough power and autonomy to deliver.

Perhaps part of the problem is only working on one type of appointment e.g. MSK – perhaps they need to branch out into other areas or speak to other suppliers who complement them and work together.

The point of this ramble was to show that good ideas aren’t always easy to implement and even working out who the customer is can be difficult.