CASE STUDY: WHAT ARE THE INNOVATION OPPORTUNITIES AND CHALLENGES FOR THE
GOVERNMENT DIGITAL SERVICE?
In the UK, general practices are the community-based front line of the National Health Service (NHS),
providing the first and most commonly-used point of access to health care. The General Practitioners
(GPs), nurses and health visitors of those practices are generalists, expected to cover a complete spectrum
of individuals’ needs: physical, psychological and social; from prevention (education, screening,
immunisation), to diagnosis, treatment and management of existing conditions. GPs are also the gateway
to access secondary care: referring patients to, and coordinating with, hospitals, specialists and other health
and community services.
The UK has around 9,800 medical practices providing over 400 million consultations per year; and referring
only 5% of those cases to secondary care. Practices can choose whether to be 24 hour services; many
provide telephone consultations, as well as online services for booking appointments, ordering repeat
prescriptions, and for patients to access their summary-level medical records. These services are provided
via the NHS, and as such, they are free to patients. In a 2011 survey of NHS users, 87% expressed very
high levels of satisfaction with their personal experiences of GPs, and 88% trust their GP to tell the truth.
However, general practices are suffering due to rising demand “far exceeding our capacity to respond”,
such that 90% of GPs believe that their workload prevents them from providing quality care. Furthermore,
their resources are falling, and are expected to continue to do so, not least because a significant number of
GPs are due to retire within the next ten years, whilst GP recruitment has dropped.
At the same time, the global medical-tech market is growing at 4% annually, expecting to reach $477bn by
2020, and as such the market is attracting venture capital. The technology industry believes that it can
provide solutions to the pressures faced by GPs, by putting much of the front line support directly into the
hands of the patients. This democratisation comes in the form of wearable technology, as well as the
100,000+ healthcare apps that already exist and continue to grow in number: an example being that patients
are already being empowered to seek self-diagnosis on their phones, using sophisticated algorithm-based
symptom checkers (such as [login to view URL]), which a patient can speak into and receive immediate “clinically
assured” responses from.
However, there are concerns, ranging from the erosion of the patient-doctor relationship, to data security;
and perhaps more obviously, are the concerns for the accuracy of the services provided and the credibility
of medical practitioners behind them. In fact, could technology actually lead to further strain on the
medical profession? In June 2015, the British Medical Journal published research indicating that, of 23
diagnosis apps tested, they varied widely in the accuracy of their diagnoses, and most were over-cautious in
their triage advice, indeed some of the applications always recommended users seek advice from their
doctor.
What, if anything, is innovative about primary health care provision?
Can technology transform the sustainability of the operating model used by general practices?
What is the potential for disruption in the primary health care industry?
Can healthcare be democratised whilst simultaneously protecting patients?
How can medical practitioners use these market innovations to influence patients’ behaviours?
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