Paul Bensley, the managing director of X-on, argues that political turmoil should not distract from a policy paper that makes important commitments on the use of cloud telephony, a technology that can support patients while reducing the administrative burdens on primary care.
Amid all the political turmoil of the past few weeks, it would be easy to overlook ‘Our plan for patients’ – the policy paper issued by the Department of Health and Social Care the day before the mini-budget.
That would be a shame – because there are some good things in it. The title suggests the department is determined to maintain a focus on patients, a good idea when so much debate about the NHS is focused on finance and efficiency.
Yet the paper itself recognises there is a need to look after the professionals who look after patients. Former health and social care secretary Thérѐse Coffey, who signed the foreword, said her priorities were abcd: ambulances, backlog, care, and doctors and dentists.
GPs are not just doctors, but the first point of contact with the NHS for many. So, it’s another positive that even though Coffey has moved on, the paper considers how communications technology can help them to improve services for patients while reducing some of the administrative burdens that they face.
Cloud telephony needs scale
In a section on ‘making it easier to access general practice’, the paper makes specific commitments on improving access by telephone. It also says that “from January 2023, we will accelerate the delivery of high-quality cloud-based solutions.”
As the word ‘accelerate’ indicates, the NHS is already working on the roll-out of cloud-telephony to general practice. NHS England has been working with procurement and digital bodies on a market engagement exercise, to find out what is available.
It has said this will lead to a new framework for general practice to use, so I hope this line in ‘Our plan for patients’ is flagging that this will be available in the New Year. I also hope that, when it comes, the framework recognises that to deliver its full benefit cloud-telephony needs to be delivered at scale.
We’ve been talking to an Integrated Care Board in a major northern city that wants to move its practices to cloud-telephony so it can offer patients new ‘self-serve’ options. Examples are ordering repeat prescriptions or checking and changing appointments without bothering busy staff.
That won’t work if every GP practice or federation picks its own system and implements it in its own way; it needs everybody to be using the same system and the same workflow. Integrated care systems have been set up to deliver this kind of integrated and personalised care, but they will face challenges.
One that has received less attention than it might is the number of contracts in place for legacy systems, with terms and penalty clauses that will need to be resolved. Without an injection of funding up-front, scale at pace may be hard to achieve.
Delivering the plan’s benefits for patients
Fortunately, the benefits of cloud-telephony are quantifiable. One set of benefits accrue to patients. ‘Our plan for patients’ recognises this, when it outlines plans to “make more time available for appointments” by “automating appointment reminder messages, consultation booking and triage responses.”
This is the basic level of self-service that all ICBs are interested in, and cloud telephony already supports it. Systems can be set up so callers can ‘press one for a prescription, two to check an appointment, and three to speak to the GP on call.’
However, there is a lot more that can be done. Calls might be routed out to other Integrated Care System services, such as community pharmacy – which ‘Our plan for patients’ wants to see expanded to “free up GP time for more complex cases.”
Or, practices might focus on those complex cases; the patients with abnormally high demands on the health system because they make heavy use of GP and other services. One of the benefits of cloud telephony is that it generates data about caller behaviour.
Dashboards can tell practices who is calling, and when, and how long they wait to get through, and who they speak to when they do. Using that data, practices can identify which patients are making repeat appointment requests; and start thinking about what a better service would look like for them.
Delivering the plan’s benefits for GPs
Another set of benefits accrue to GPs. ‘Our plan for patients’ flags this, when it talks about “introducing digital tools and improving IT to ease administrative burdens”, alongside a commitment to automating messages, booking and triage.
I understand there is some scepticism about this. I have seen pushback in the press about how more phone lines or digital triage tools will help general practice if there are no more people to answer the phones or do the work.
However, one of the problems with telephone triage at the moment is that many practices are trying to make it work without the right technology. We have been talking to a lot of practices who have been telling us that the GP on call is handed a printed list of patients to phone.
When they try to work their way down the list, they find that many patients don’t answer, or they don’t have the information they need to respond to them without doubling their workload by asking them to come into surgery.
One of the benefits of X-on’s cloud telephony system, Surgery Connect, is that a GP on triage duty can set up a list of patients on screen and call them with a single click. They can send a patient an SMS message to keep them informed about what is happening, so they can be ready for the call.
If the patient is worried about a rash, or a wound, the GP can ask them for a high-definition photograph. And if the patient doesn’t need an appointment, but does need advice or reassurance, the GP can send them an SMS with an appropriate weblink.
Surgery Connect integrates with the major GP record systems, so the GP on call has the patient’s medical history at hand; and at the end of a triage session, the call history and consultation call is written back to the record for review.
Let’s focus on delivery in 2023
Cloud telephony makes the whole process of delivering the commitments in ‘Our plan for patients’ more efficient and a better experience for both patients and GPs. Which is why it is good to see it given such prominence in this policy paper.
The challenge will be delivery. Although the Department of Health and Social Care presented ‘Our plan for patients’ as a plan for winter, it is too late to agree, procure, and implement new ways of working, at scale, this year. However, if NHS England and its partners can “accelerate the delivery of high-quality cloud-based telephone solutions” from next January, it will put primary care in a much better position for 2023.
So, perhaps, the best thing about ‘Our plan for patients’ is that it holds out a promise to GPs and patients – technology can help, and proven technology is on the way.