Millions of patients will be encouraged to use digital technology to assess how ill they are under a groundbreaking initiative by a leading NHS hospital, as part of a drive to reduce the use of A&E and outpatient appointments.
A revolution in the NHS’s embrace of technology will see patients in Birmingham advised to use online – live and automated – chat services, online symptom checkers and video consultations with doctors and nurses to help relieve the “unsustainable” pressure on services.
University Hospitals Birmingham (UHB) trust has decided to push through radical changes that it hopes will transform how hundreds of thousands of patients a year receive NHS care and treatment.
Under their plans, people thinking about seeking help at A&E will be encouraged to instead to undertake a two-minute online check of their symptoms before they go to hospital. The “artificial intelligence triage” will then tell them if they need to seek treatment or not.
Patients will also be able to talk to their consultant using their smartphone at home or work and not have to go to the hospital itself for an outpatient appointment. Consultations done that way would be more convenient for many patients, but would mean they no longer undergo a physical assessment of their health.
“The way patients access and receive healthcare in Birmingham will be unrecognisable in five to 10 years’ time, with technology playing a hugely enhanced role,” said Dr David Rosser, the trust’s chief executive. “This is the first case of technology of this kind being deployed at such a scale to aid the hospital sector.
“We think that we can get 70% of our 2 million outpatient appointments on to this way of doing things within two to three years.” In a departure from 70 years of previous NHS care, patients choosing that option would in future be managed entirely online and not be physically assessed.
The trust also hopes to relieve the pressure on the A&E units at the four acute hospitals it runs in Birmingham by persuading the 30% of people it deems “avoidable attendances” because they have minor ailments to use the symptom checker instead. It will be branded as “A&E Online” or “UHB Online”.
Patients using the new ways of engaging with the NHS would avoid long queues in A&E, or be reassured that they do not need any medical attention after all, or be advised to see a GP or pharmacist instead, Rosser added.
“If you can have your outpatient consultation through a device of your choosing in a place of your choosing – at home or at work – then you don’t have to take time off work and come to the hospital.
“In the ‘virtual clinics’ we already run for people with liver problems, there’s a video link where you see the doctor’s face on half the screen and the other half of the screen displays your letters or results of your scan, for example,” he said.
People have talked for years about healthcare harnessing the potential of technology. How significant are the University Hospitals Birmingham (UHB) trust plans?
Very. This is one of the NHS’s biggest trusts and hopes to bring about far-reaching changes in the way people access services at its five hospitals. A few trusts and GP surgeries have used technology to replace traditional face-to-face appointments, but in a limited way. No NHS care provider has yet tried to alter patient behaviour so comprehensively and so quickly.
How will it take pressure off A&E?
“A lot of patients go to hospital because that’s the only way they can easily access medical advice, with such long waits to see a GP. Some 30% of those who attend emergency departments don’t need any complex diagnostics or treatment,” explains Lawrence Tallon, UHB’s director of strategy.
UHB will encourage patients in the Birmingham area to use a new online symptom checker, which will be called “A&E online” or “UHB online”, to check if they are unwell. Some will be reassured and seek no further care, others will go to a GP or pharmacist, but those needing urgent care will be offered a video consultation with an A&E nurse or doctor. Some will then be told to come to hospital.
Those with a sore throat, back pain or joint pain, for example, will answer questions on their phone, tablet, laptop or desktop about their symptoms before being advised what to do. Many will be told not to come to A&E.
How will technology remove the need to attend an outpatient appointment?
In several ways. UHB will hugely expand its so far only limited use of “virtual clinics”, in which patients have remote consultations by video, to cover all major conditions.
In addition, people with a long-term condition will be encouraged to regularly monitor their own health themselves, perhaps using Fitbit-style wearable technology, and send the results to the NHS.
For example, diabetics could keep track of their blood sugar levels, weight and recent food intake themselves and send the NHS the results. Doctors hope that will help keep people with long-term conditions healthy and thus avoid a sudden deterioration in their condition.
It should also pick up early signs that a patient may be about to experience a setback. For example, a doctor may advise someone with a high blood pressure reading to take extra medication to reduce the risk of a stroke or heart attack.
UHB plans a “massive expansion” of such clinics, eventually covering every medical speciality.
Research that pollsters Ipsos Mori undertook for the Health Foundation, which was cited in the recent NHS long-term plan, found that around two-thirds of the public across all age groups are happy to have a video consultation with their own GP rather than a face-to-face appointment.
The expansion of online interaction with the NHS is likely to raise fears that the loss of face-to-face contact with health professionals could compromise patient safety.
The scheme will also spark controversy about creeping privatisation of NHS care because the trust plans to implement the changes in conjunction with a private firm, Babylon Health. It has been accused of undermining the NHS by enticing patients to stop using their usual GP practice and instead switch to its GP At Hand service, which is based on remote consultations. When patients join them, their GP surgery stops receiving annual payments from the NHS for their care, which GP groups have warned threatens the future of general practice.
More than 50,000 patients in London have already signed up to receive their GP care through GP At Hand, and NHS England has given it permission to start operating in Birmingham too. An estimated 85%-90% of patients who have their consultation that way do not go to have a face-to-face appointment with a GP, though it has surgeries where patients can do so.
UHB will use modified versions of GP At Hand’s existing technology to help it manage the growing number of patients with chronic conditions, such as diabetes and heart problems.
“The collaboration being discussed between UHB and Babylon will help outpatients, primary care and emergency care to go digital, supporting people across Birmingham and beyond to take control of their own health and avoid the hassle, expense and carbon footprint of unnecessary travel to the hospital or GP surgery,” said Paul Bate, Babylon’s managing director for NHS services. Bate has been a civil servant in Downing Street and the Cabinet Office specialising in health policy under the premierships of David Cameron and Tony Blair.
A briefing paper on UHB’s plans approved by its governing board on Wednesday states that it is forming a “collaboration” with Babylon to help it “transform the model of healthcare using technology to better manage demand”. Their talks about “areas of potential collaboration” have centred on three areas:
• virtual outpatient consultations and chronic disease management
• pre-hospital triage for unscheduled care
• referral pathways from GP At Hand to UHB services and vice versa.
UHB’s attempt to reshape the NHS’s relationship with patients will be closely studied by other trusts pondering how to deal with the increasing load on them caused by the growing, ageing population.
It will delight Matt Hancock, the health secretary, who is an avid advocate of using digital technology to make care quicker and more convenient for patients and also improving the diagnosis of illness while relieving the burden on NHS staff.
