The new GP contract didn’t mention innovation once. Yet the space it opens up for innovation is exciting, and we should seize it

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The new GP contract didn’t mention innovation once. Yet the space it opens up for innovation is exciting, and we should seize it

Dr Caroline Chill, Clinical Director for Healthy Ageing at Health Innovation Network looks at the potential of the new contract to support innovation.

I’ve worked in primary care for over 30 years, and have been involved in leadership and innovation for most of them. GPs have a history of being innovative with the early coded electronic health record systems being a prime example. In recent years, it has felt like this innovation has been stifled by increasing workload, staffing pressures and ever changing contractual requirements. I’ve seen innovation talked about in countless different ways and these days it seems to me that policy makers are falling over themselves to describe initiatives as ‘innovative’ or to talk about the potential to improve care through innovation but with less commitment to support the delivery of innovation in practice. So, I was fascinated to see how this would be expressed in our new GP contract which to my surprise did not mention the word ‘innovation’ at all. Not a single mention, despite the contract being extremely innovative.

An obvious area relates to support for Primary Care Networks and additional staffing. The aim of Primary Care Networks is to connect the primary care teams to help deliver more integrated and comprehensive local services, to allow new models of care to emerge and to support higher levels of self-care. From 1July, 1,259 Primary Care Networks become operational and backed by nearly £1.8 billion funding over five years with most of England’s nearly 7,000 GP practices participating.

Additionally, the interim NHS workforce plan and dubbed the “People Plan” was published in June.  This focuses on three key areas – recruiting more staff; making the NHS a great place to work; and equipping the NHS to meet the challenges of 21st century healthcare.  It re commits the government to delivering 5,000 full time equivalent GPs “as soon as possible” as well as nearly 6,000 extra nurses, and the creation of “nursing associates” offering a career route from care support into registered nursing.

The GP contract acknowledges the fact that the additional staff we need in general practice will not come from doctors and nurses alone. The money available through the contract can be used to help recruit a much broader range of professionals – Initially the scheme will meet 70% of the costs of additional clinical pharmacists, physician associates, first contact physiotherapists, and first contact community paramedics; and 100% of the costs of additional social prescribing link workers.

I think it will be down to the primary care networks to find innovative ways to recruit, train, support, mentor and part fund these new roles. This is no simple task as the existing training and skills of these professionals will need to be strengthened and adapted for working in community settings, where there is less supervision and where patients need holistic care, encompassing multiple physical, social and psychological issues.

I believe GPs will rise to this challenge and seize the opportunity. . It could be the beginning of a new, more modern and holistic way for patients to experience general practice.

Increasing the numbers of physiotherapists and other community-trained staff could lead to another important shift. Take MSK as an example which includes chronic knee, hip and back pain, has a major impact on an individual’s quality of life and society. It is the second most common reason for GP visits, accounts for around 25% of all GP consultations and is estimated that 9.3 million working days are lost in the UK to MSK problems.

An intervention that relieves chronic joint pain, called Joint Pain Advice , already exists and can be delivered by a wide range of professionals and lead to lasting improvements in pain. The model focuses on reducing reliance on painkillers through exercise and education. Trained professionals, who could be physiotherapists, community health trainers, or others provide a series of face-to-face consultations, working collaboratively with people with hip and/or knee osteoarthritis and/or back pain, focusing on supporting self-management. The programme consists of up to four 30-minute face-to-face consultations between the advisors and people with hip or knee osteoarthritis (OA) or back pain. Patients attend an assessment where they discuss their lifestyle, challenges and personal goals and then jointly develop a personalised care plan that gives tailored advice and support based on NICE guidelines for the management of OA. They are then invited to attend reviews after three weeks, six weeks and six months to access further tailored support and advice. This has the potential to reduce pressure on existing physiotherapy services and potentially reduce demand for GP follow up consultations.

To date, more than 500 patients have used the service led by physiotherapists. In a previous pilot in Lewisham, south London, they reported less pain, better function and higher activity levels. A high satisfaction rate was achieved which included reduced BMI, body weight and waist circumference and has led to fewer GP consultations, investigations and onward referrals.

In addition to the patient benefits, for every £1 spent on the programme there is a saving to the health and social care system of up to £4, according a Social Return on Investment (SROI) analysis.

Why not embed this training into these new roles? This could genuinely help deliver one of the aims of PCNs to empower people to self-care and improve the quality of life for people living with MSK pain. This one example could radically change the approach for addressing the needs of people living with MSK pain helping them to become fitter, more active and more empowered,  provided that the additional funding for primary care staffing does not result in reduced provision in other sectors.

Primary care will find countless other ways of using new staff to do more in primary care. While this doesn’t magically reduce our workload in practices, it has the potential to shift it and makes it easier for patients to access a broader range of professionals in community settings without the need for referrals to hospital.

These initiatives alone will not be enough to completely transform and modernise primary care but they are a great starting point. Change is easy to talk about but difficult and complex to enact. Even innovations that will lead to significant savings will often require upfront investment of resources, time and goodwill. The introduction of state based indemnity is very welcome to help retain experienced GPs, however,  changes to pension contributions and tax implications may have an equal and opposite effect impacting  the number of sessions doctors are choosing to work.

For me the key headlines which make the new GP contract so innovative and exciting are the significant increased staff funding, support for the development of Primary Care Networks, a five-year timeline and introduction of state based indemnity.  What we now need is the time and space to deliver.

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Meet the innovator: James Flint

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Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with James Flint, CEO and Co-Founder at Hospify; a compliant, trusted healthcare messaging app.

Pictured above R – L: James Flint, Co-founder and CEO with Neville Dastur, Co-founder at Hospify.

Tell us about your innovation in a sentence

Available for free in the Apple and Android app stores, Hospify puts a simple, affordable alternative to non-compliant consumer messaging services like WhatsApp, Viber, Telegram and Messenger directly into the hands of healthcare professionals and patients.

What was the ‘lightbulb’ moment?

Meeting with the Head of Health for the Information Commissioner’s Office in 2015 and discovering that, while a very big chunk of the NHS was using WhatsApp to communicate while at work, once GDPR arrived in 2018 they were going to have to stop doing this.

What three bits of advice would you give budding innovators?

    1. Be prepared for the long haul. And I mean long.
    2. Keep it simple.
    3. Never miss lunch.

What’s been your toughest obstacle?

Getting sufficient funding, without a doubt.

What’s been your innovator journey highlight?

Getting on the NHS digital heath accelerator last year. It felt like we’d finally been given the official stamp of approval.

Best part of your job now?

Meeting nurses and hearing directly from them what a difference Hospify can make to their working lives.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Implement and support proper health data interoperability standards. I know this Is finally happening, but it’s still the most important single thing that needs to be done.

A typical day for you would include..

Answering a lot of email, talking to my development team, meeting or calling potential investors, networking or promoting Hospify at some kind of health event, answering customer support questions about the platform. Usually all on the same day and sometimes all at the same time!

For more information on Hospify visit www.hospify.com, Facebook, LinkedIn or follow them on Twitter @hospifyapp

Meet the innovator: Lydia Yarlott

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Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we caught up with Lydia Yarlott, Co-Founder at Forward Health; a secure messaging and workflow app, connecting care workers around patient pathways.

Pictured above: Lydia Yarlott.

Tell us about your innovation in a sentence

Forward is a mobile communications platform aiming to connect healthcare professionals for the first time.

What was the ‘lightbulb’ moment?

Probably being a first year doctor on my own in an NHS ward at 2am in the morning trying to get help for a deteriorating patient and being unable to contact anyone. Poor communication leads to a real feeling of helplessness, and I want to change that for doctors and nurses everywhere. It’s hard to believe we’re still using pagers and resorting to WhatsApp to get hold of each other in hospitals, so it wasn’t so much a lightbulb moment as an increasing feeling that something had to change!

What three bits of advice would you give budding innovators?

    1. Talk to everyone, and anyone, you can about your idea. You never know what will happen next. My great friend Will worked with me as a junior doctor; he’s now with us on Forward full-time. We never would have had him as part of the team if we hadn’t spent hours on night shifts discussing the problem together!
    2. Find a Co-Founder (or several!) I couldn’t imagine doing this alone. Philip and Barney are both amazing people and amazing leaders, and it’s their drive and optimism that got us to where we are today – 5% of the doctors in the UK and growing. Whenever one of you is losing faith (inevitable at times!) the others can put you back on your feet and help you with that resilience you need in spades to be a successful Founder.
    3. Care about your problem more than your solution. Get as close to it as you can and stay there. Your solution will be wrong first time around, but as long as the problem isn’t solved, you have a chance of something really worthwhile.

What’s been your toughest obstacle?

Personal doubt!

What’s been your innovator journey highlight?

Getting our first real use cases. Watching our product change the way people work, resulting in better, faster care for patients. We have an amazing group of physios and orthopaedic surgeons using Forward to streamline shoulder surgery for patients, and another group who are using it to coordinate the multidisciplinary team in paediatric allergy. I can’t get enough of those stories because I know how tough it can be on the frontline of the NHS.

Best part of your job now?

The great privilege of working as a doctor and as a Co-Founder. I love clinical work, but I get frustrated by outdated systems, and I would hate it if I couldn’t focus on changing that. I care about healthcare at a systemic level and I want the NHS to survive, but I know that for that to be the case things will have to move forward, fast. I want to be a part of that.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

Get Trusts talking to one another and sharing what they do. Incentivise knowledge transfer – both successes and failures. Share the ways in which they are working with others, including start-ups and small businesses, to foster innovation at scale.

A typical day for you would include..

A typical day being a paediatrician is just that – looking after sick children! I’m a junior doctor, so I’m still learning a lot, and working closely within a team to achieve the best outcome for the patient. When I’m at Forward, I spend most of my time meeting with the team to discuss progress and strategy, representing the clinical face of the company and the problem we’re trying to solve. The two jobs couldn’t be more different, but ultimately they are focused on the same thing – improving healthcare for everyone. I love what we’re building at Forward and I love the team – even those of us who aren’t from a healthcare background are driven by the mission to improve communication, and you can feel that energy walking into the office.

For more information on Forward Health visit www.forwardhealth.co or follow them on Twitter @ForwardHealth_

Meet the innovator: Vivek Patni

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Meet the Innovator

In this series we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Vivek Patni, Director and Co-Founder of WeMa Life; an online marketplace that brings customers and their families together with social care and community care service providers.

Pictured above: Vivek Patni.

Tell us about your innovation in a sentence

WeMa Life is an online marketplace that brings customers and their families together with social care and community care service providers; giving choice, accessibility and efficiency in the service procurement and delivery pathway.

What was the ‘lightbulb’ moment?

As an informal carer for my grandfather, I was immediately shocked by the lack of innovation in supporting families to find, coordinate and manage local care services for their loved one, hence WeMa Life was born. I find online marketplaces very convenient and use them for so many aspects of my life – products, clothes, hotels, restaurants – I knew a similar digital environment was needed for care services. Using WeMa Life as a customer I can search, compare, purchase and rate local care services whilst as a provider I can digitise the outdated, manual, paper-based visit records and manage my daily business activity.

What three bits of advice would you give budding innovators?

    1. Stay flexible: it’s tempting to start a business with a clear idea of how things will unfold; but this is rarely the case. Pivot and react to obstacles and have an open approach to finding the best solutions to all your problems.
    2. User experience: test your product constantly and get as much feedback as you can from all your user groups. Simple solutions sit very well in such a diverse industry.
    3. Be creative in your approach to developing tech and running your business. There are so many applications and tools to create efficiency and cost saving in finding resources, marketing and development, so use them!

What’s been your toughest obstacle?

Where I had faced the difficulty from a customer side of social care, I was less aware of the complexity in delivering publicly funded social and community care to different user groups. This meant learning the nuances of each service type/provider and creating a fluid product that would fit all.

What’s been your innovator journey highlight?

Designing the tech architecture from scratch, building an international technology development team and bringing my ideas to life in just eight months is something I am very proud of.

Best part of your job now?

Taking my product into the market! Now that the product is live, I am driving its use through digital marketing and sales. I meet so many interesting people on a daily basis who bring exciting new ideas to what we do – my mental technology roadmap is never ending.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

I would give more opportunity and financial incentives to SME’s. There are a huge number of SME’s with great ideas and technology, they tend to be more fluid, interoperable and customisable to the needs of the NHS; they would be able to make a real change to the daily lives of providers and customers.

A typical day for you would include..

Typically, my days are devoted to technology and selling. My morning tends to be engagement with my India tech team to make sure we are always refining and innovating our solution. Afternoons will be selling, calling and meeting as many people as I can. I get energised by talking to people about what we do so I try to do that as much as possible.

For more information on WeMa Life visit www.wemalife.com or follow them on Twitter @wemalife

Meet the Innovator

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Meet the Innovator

Each issue we’ll get up close and personal with an innovator asking them to share their thoughts and experience from their journey into the world of health and care innovation. In our latest edition, we spoke to Dr Sukhbinder Noorpuri, Founder and CEO of i-GP, an online consultation platform to allow patients faster access to primary care for minor illnesses.

Pictured above L-R: Dr Sukhbinder Noorpuri with Co-Founder, Dr Aleesha Dhillon.

Tell us about your innovation in a sentence

i-GP provides digital consultations for minor illnesses, using interactive pictures and online questions. It is accessible to patients 24/7 from any device, and 90% of users can start their treatment within just one hour.

What was the ‘lightbulb’ moment?

When I was working as a GP, I met Michael, a 70 year old gentleman who waited three hours to see me at a walk in centre back in 2015. I thought that there must be an easier way to access healthcare. So I started looking into alternatives, and when I found none, I decided to go about creating one. I have been fortunate enough to have a great Co-Founder in Aleesha who has been instrumental in developing creative solutions to all the challenges that we have encountered.

What three bits of advice would you give budding innovators?

  • Have a vision and make it a big one – set your goals globally rather than just locally in the spirit of true disruption.
  • Be relentless in the pursuit of this vision and always try and learn from every experience or opportunity which comes your way – know your market, keep reading about it and stay focused.
  • Build a world class team and inspire them to believe in the company mission. Be confident in your leadership and enjoy the process. A successful entrepreneur may build a well respected company, but a successful team will change the world.

What’s been your toughest obstacle?

Healthcare innovation is very challenging because impact takes time to achieve. However, your clinical experience is really the key differentiator in the marketplace. If you genuinely feel you have a clear perspective on the problem and have created the solution then building the evidence for your product, despite being time consuming, is the clearest way to show its potential.

Some regard regulation as being a tough element of service delivery, but embrace the challenge as a well executed process is the reason you will stand out in the industry.

What’s been your innovator journey highlight?

Over the last three years, we have won or been shortlisted for 22 healthcare awards as a result of the innovations we have developed in digital care. This has led us to international recognition and the opportunity to showcase i-GP at Conferences all over the world.

Learning to adapt and raise healthcare standards has been a reflection of the dedicated team approach to the venture. However, this recognition is secondary to the feedback we receive from our patients as this is our main driving force. Impacting the patient journey to care on a daily basis  is the motivation and inspiration to transform traditional routes of service. For example last week, we treated a patient who was due to catch a flight abroad for her sister’s wedding but was suffering with a urinary tract infection. It was late at night, she was in a rush and her chosen pharmacy was closed. We managed to arrange her prescription at the chemist within the airport just before she was due to take off. When she returned she was so thankful that her trip hadn’t been ruined by illness and she had been well enough to enjoy the celebrations.

Best part of your job now?

Without a doubt, my greatest fulfilment comes from leading our team. We are all passionate about seizing this opportunity in time to showcase the good that technology can bring to healthcare and the NHS. Digital health is still very much in its early stage of adoption and even though smartphones have been commonplace for several years, we are still on the cusp of widespread digital use. The service that we implement today, we hope, will continue for many years to come.

If you were in charge of the NHS and care system, what’s the one thing you’d do to speed up health innovation?

There has been a real drive recently with Rt Hon. Matthew Hancock advocating technology to modernise the NHS. Accompanying this, are the additional Government funds being made available to trial new products. This combination offers a paradigm shift from previous regimes and as innovators, we are very much looking forward to this filtering down to provide new opportunities. I also feel it is imperative that decision makers utilise patient feedback to help determine the future course and not just rely on industry advisers.

A typical day for you would include..

Most days are very varied due to the wide scope of avenues we are exploring at i-GP. I usually like to hold key meetings in the morning with either members of the team or board to review processes and define our future strategy.

We have a schedule over the week to assign time to all the key aspects of service from marketing to patient outcomes and from technology developments to the financial structure we have adopted. Reflection is part of this process and the opportunity to network with other innovators is often on the timetable to ascertain the potential for collaboration.

Liasing with the Accelerator team and our navigator Sara is also a key part of our time as we look to integrate further into the NHS.

We would like to take this opportunity to congratulate Dr Sukhbinder Noorpuri who recently won the Chairman’s Entrepreneur Award (pictured above) at the TiE Awards Wednesday 5 December. Find out more about the awards here

For more information on i-GP visit i-gp.co.uk or follow them on Twitter @wellness_igp_uk