Levelling up – how digital can help address health inequalities

by Annabelle Sanderson

There has been a significant amount of discussion this week regarding the changes needed to allow primary care to be sustainable. The rapid transition to digital ways of working has caused controversy and led to a clamour for patients to insist on a face to face appointment with their GP. 

GPs have hit back and said the door was always open for patients who needed an in person appointment and backtracking on the digital first methods will cause unsustainable pressure on an already creaking profession.

The Queen’s Speech earlier this month said the government would “level up opportunities across all parts of the United Kingdom”.

And nowhere is this more important than in healthcare.

The inverse care law states that the availability of good medical or social care tends to vary inversely with the needs of the population it serves. The proposer of the model, Julian Tudor Hart, explained it simply when he said: 

“Rich people get lots of it. Poor people don’t get any of it.”

Since it was first discussed in 1971 it’s been a continual topic of debate and not just within healthcare, because good health underpins the overall health of a nation in its ability to function. As former Secretary of State for Health Frank Dobson said, 

“Inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you’ll die sooner because you’re badly off.” 

The statistics back up the premise. According to data taken from primary care records, people who live in poorer areas have shorter GP appointments despite being more likely to have complex health needs. 

The Health Foundation’s report has reiterated the importance of including primary care in the overall ‘levelling up’ strategy. 

Primary care is the part of the NHS the public interacts with the most: it is the gateway to most health services provided by the NHS. Combined with an increased pressure on resources and a shortage of staff, we are heading towards a situation where without change it will become unsustainable. 

These facts were behind the NHS’s ‘Digital First’ strategy; aiming to allow under doctored areas to be served by clinicians using digital methods as a way of reaching a wider patient population. There is no doubt that in areas of high social deprivation it is harder to access care – and that means shorter life expectancy and health complications affecting day to day life including the ability to work and exercise. 

It is the people with complex health needs who are the most expensive to treat. People with multiple co-morbidities, such as COPD, hypertension or diabetes will need more involvement with healthcare providers than someone who is usually fit and well. 

Primary Care Networks were designed to help address part of this problem. By combining resources, such as first contact physiotherapists or clinical pharmacists groups of practices could ‘club together’ to share a member of staff to work across the group.

But what is also increasingly apparent is that without digital methods of working with patients, there will never be enough staff to go around. 

That’s why it is so important not to disregard the developments we have made in how patients contact their surgeries because of some alarming media headlines. 

Seeing a GP face to face does not guarantee nothing will be missed. Speaking to then on the phone or video consultation does not rule out a face to face appointment or onward referrals to specialist units or diagnostic tests. 

“Over the last year I have referred people for tests without them sitting in front of me and the ability to have a more efficient way of working has allowed me to see up to five more patients a day,” says Dr Jay Verma, GP in North West London.

“Sharing resources and working remotely requires good, trustworthy technology which is why I have been championing the use of Medloop in completing long term condition reviews in my practice and others within my PCN,” he adds.  

“Its method of combining digital and traditional methods of contacting patients and allowing them to fill in surveys detailing their symptoms not only saves the time of a healthcare professional but it saves that patient time too.”

“By my calculations, using software to help clinical staff work more efficiently has allowed us to not only complete more reviews on patients and ensure that those who have concerning symptoms are seen first, it has freed up on average one full time equivalent staff member in consultation time. That’s time which can be devoted to the patients who have urgent care needs or need physical examinations and treatment.”

“Not all technology is great. Some of it can actually increase our workload which really is the worst of all worlds. But just because some trials have failed, that’s no reason to dismiss the improvements which digitalisation in healthcare can bring for all.”

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