Author: Alison Griffiths

We may have passed the longest day of the year but it is only now that the heat of summer is starting to be felt in the UK. On 24^th June the UK Health Security Agency (UKHSA) and the Met Office combined to issue a four day heat health alert. And although no area of the country saw an official heatwave, in which temperatures go above a set threshold for three days in a row, the end of June did deliver the promise at least of a hot summer.

After a cooler than normal spring, the prospect of a few days of warmth is inviting. But there is a difference between warm temperatures and the soaring mercury which can have a serious impact on our ability to function. And for those working in health related areas, that impact cuts across patients and staff alike; increasing workloads at a time when minds feel dull and limbs heavy in the excessive heat.

That’s when even small interventions such as taking regular water breaks and eating small amounts regularly rather than big meals can make a difference. So too can taking steps to shift routine workloads such as phone answering or appointment management to others in order to create time and space to step back and reset mind and body for the work ahead.

Perhaps it is a good thing therefore that people are starting to take more notice of the impact of heat and looking for ways to mitigate it. Certainly, visits to the NHS heat exhaustion advice page more than doubled in the first two days of the heat alert period; with more than twenty-eight thousand visits to the page. And the more publicity this potentially dangerous side-effect of summer receives the better.

According to a Red Cross report ‘Feeling the Heat’ in the summer of 2020 more than two and a half thousand excess deaths occurred due to summer heat in England. That figure is expected to treble by 2050. Babies and young children, the elderly, those who are pregnant or have a range of underlying health conditions are more vulnerable. However, despite the Red Cross report commenting that only 9% of adults believe that they are vulnerable in heatwaves, heat stroke can affect anyone.

Heat exhaustion on its own isn’t necessarily life-threatening. Unless, that is, if individuals fail to treat it swiftly by cooling down and replacing lost fluids. That’s why knowing when to stop and take a step back is so important. Symptoms of heat exhaustion can include tiredness, dizziness, headaches, and feeling sick.

When not treated on time or if there is prolonged exposure, particularly to physical stresses in hot temperatures, heat exhaustion can develop into heat stroke. When this occurs the body’s temperature becomes dangerously high. Other symptoms might include fast breathing or shortness of breath, a fast heartbeat, confusion, a seizure, or loss of consciousness. Without rapid intervention heat stroke can lead to a swelling in the brain or organ damage and can be fatal.

Over the last five years the proportion of people aged over sixteen in England who report long-term back, joint, or arthritis problems has little changed.  Standing at 18.8% in the year ending March 2018, the figure as at the year ending March 2023 had only eased slightly to 18.4%.

That’s one reason why the WorkWell scheme which we covered in our May 2024 article is so important; helping individuals to live and work with long term including musculoskeletal conditions. This new data also helps to illustrate just why those who work in fields such as physiotherapy, osteopathy, and pain management are under constant time pressure as they look to meet the needs of those with ongoing musculoskeletal problems.

Delve beneath the data and some interesting trends emerge. The numbers of emergency hospital admissions for hip fractures in the over 65s and rheumatoid arthritis prevalence in the over 16s are little changed over the time period covered by the data. However, the prevalence of osteoporosis in over 50s has risen from a low of 0.17% in 2014/15 to 0.97% in 2022/23. This echoes an ongoing trend over a longer time period which experts have put down to an increase in worldwide population aging.

According to the International Osteoporosis Foundation, the condition is now being seen as the fourth leading cause of chronic disease morbidity in Europe, behind ischemic heart disease, dementia and lung cancer. And although osteoporosis is primarily a female disease, statistics show that the residual lifetime risk of developing osteoporosis in men aged over 50 is actually higher than the risk of them developing prostate cancer.

The musculoskeletal health data was one element of a suite of new health trends in England data released by the Department of Health and Social Care. The underlying data comes from Fingertips, a large public health data bank. According to the Department of Health and Social Care the data will now be updated and released on a monthly basis.

Other health trends data released as part of the same programme looks at areas such as life expectancy, smoking, obesity, childhood development and anxiety. Here again the underlying data makes interesting reading. Some, such as the graph showing deaths from preventable causes, reveal quite clearly the effect of the Covid Pandemic on mortality rates. Other graphs potentially might indicate the benefit of proactive interventions or improved medical care. For example, stroke prevalence has seen a rise from 1.7% to 1.8% over the past twelve years and yet deaths from strokes in the under 75s has fallen from 15.2 to 12.6 per 100,000. Sadly, some of the statistics provided starkly illustrate a worsening health challenge with diabetes, heart failure, atrial fibrillation and hypertension all revealing upward trends.

Clinic Appointments offers backup services to practitioners primarily working in the health sector. From telephone answering and diary management to the provision of patient records software, Clinic Appointments aims to provide a professional service to clients of health providers, thereby enabling the providers in turn to focus on client treatments.

In the 2023 Spring Budget the Government announced their intention to introduce a Work Well programme. This, it was anticipated, would be designed to Integrate work and health support, thereby helping individuals who might be out of work, or at risk of falling out of work, due to health conditions.

One year on and more information has been issued about the roll-out of pilot WorkWell schemes. Fifteen areas of the country have been designated to run pilot schemes, starting in October 2024. These range from city conurbations such as Birmingham and Solihull, Greater Manchester, and North West London to more rural or mixed population areas such as Cornwall and the Isles of Scilly, or Lancashire and South Cumbria.

Within these fifteen areas the intention is to initially identify some 59,000 individuals who would benefit from integrated health and workplace support. It is envisaged that those identified in the first instance would be in work but suffering from a mental or physical condition which has resulted in their being signed off work on a long-term basis. Individuals will be able to self-refer to the WorkWell service, or they may be referred by their GP, employer, or other local service.

Support on offer by the WorkWell service will start with a personal assessment, following which an agreed support and therapy plan will be put in place. This may include physiotherapy or mental health counselling, but will also include employment advice and referrals to other local resources such as training or support groups. Crucially, the programme appears to understand that individuals may require multiple levels of assistance. For example, the announcement cites an individual whose back pain may be so severe that it also has an effect on their mental wellbeing and that therefore they would require physical and mental health therapies.

As an aside, an interim report from a three-year project on the effectiveness of digital mental health technologies (DMHT) has highlighted the patient perception that DMHTs should be seen as part of a wider treatment package which might include regular therapy sessions and/or medication rather than as a substitute treatment option.

Initiatives such as the WorkWell scheme highlight the important role which counsellors and other health professionals such as physiotherapists can play in supporting people to return to or stay in work. Commenting on this Ash James, director of practice and development at the Chartered Society of Physiotherapy (CSP) said: “Additional support to help people stay in work, or return as quickly as possible, is obviously a good thing and physiotherapists are experts in identifying a person’s needs and putting place a rehab plan, including any adaptations that can be made in the workplace.” However, they also highlighted the pressures being faced by health professionals including staffing.

Meanwhile Matthew Taylor, chief executive of the NHS Confederation, said: “with the right support, people living with poor health and long-term conditions can find that good quality work helps prevent them from becoming more unwell. This helps people to live a fuller life, which in turn reduces pressure on health services.”

There is little doubt about the increasing part which technology such as data, phones or the use of apps has to play in the delivery of health services. Nor is there any doubt about the way in which, properly planned and executed, technology can save time and resources whilst enhancing patient outcomes. To illustrate this we have chosen three stories which were released in March 2024, but we could easily have picked many more.

Our first example comes from the Arthritis and Musculoskeletal Alliance (ARMA) an umbrella organisation which brings together ‘patient organisations and professional bodies representing the breadth of musculoskeletal health.’ Their report into the impact of living with musculoskeletal conditions makes a number of recommendations for professionals including supported self-management, shared ownership of services and moving services into community spaces.

Importantly, the report also highlights the importance of having ‘robust and accessible epidemiological, clinical and outcomes data’ in order to better target the help needed. Not only that, once providers have a better understanding of potential barriers they can draw up programmes and communication methods which will speak more directly to those in need of help.

The second example arises from an initiative to improve telephone contact across GP practices. Trials of a digital system which enabled GP teams to better manage multiple calls resulted in over a thirty percent increase in patients being able to contact their practice. Meanwhile one Warwickshire practice reduced the number of patient-abandoned calls by 90%, simply by analysing call data and ensuring extra staff were on hand during peak times. Of course, not all health practices will be able to provide extra staff in that way but that is where additional phone answering back up such as that provided by Clinic Appointments comes into its own. We can provide as-needed call answering and appointment booking capabilities when health practices are stretched.

Our third technology story also comes from the NHS, this time reporting on a new prescription feature within the NHS App. This enables patients to not only order their prescriptions via the app but also to see when those prescriptions have been issued and sent to a nominated pharmacy. The app also now includes a feature which enables individuals without a nominated pharmacy to use an embedded barcode to collect prescriptions from any pharmacy.

The increasing popularity of the NHS app has resulted in a 79% increase in use from February 2023 to February 2024 with twenty-nine million views in the most recent period. Commenting on the app Dr Vin Diwakar, National Transformation Director, at NHS England said: “We’re delighted to see so many people making use of the NHS App’s new prescription feature. The service is one of many features on the app, which is helping to reduce the administrative burden for general practice as well as making it easier for people to access NHS services.” And of course, the more that people become comfortable with the NHS app the more that they are likely to accept other interactive technologies across health services such as online booking with secure card processing as required.

There’s nothing new about the warning that ‘if it seems too good to be true it probably is.’ Perhaps most often used to describe scam investments promising over the top returns, unfortunately the warning can also apply to so many other aspects of our lives. Most recently ultra-processed foods have hit the ‘if it seems too good to be true’ spotlight.

Relatively inexpensive and quick to prepare, the problem with ultra-processed foods is that they perfectly match a 24/7 always-on lifestyle. When life is taken at a rush then we are all too quick to grasp at anything which can help to save time. And some ultra-processed foods perfectly fit that bill.

Unfortunately, as one commentator, Dana Hunnes, PhD, a senior clinical dietician at the UCLA Medical Center, said: “An ultra-processed food is a food that resembles nothing of its component parts/ingredients” before adding: “An ultra-processed food has been stripped of its nutritional value (essentially).” With that in mind perhaps we should not be surprised when an umbrella review of ultra-processed food studies revealed that these products are linked to more than thirty health conditions including heart disease, mental health disorders, and cancer.

So strong is the correlation that ultra-processed foods have been shown to increase the risk of death due to cardiovascular disease by 50%. A similar level of risk was also associated with anxiety and mental disorders whilst Type2 diabetes was 12% more likely in those who included these foods in their diet. And with 57% of UK daily energy derived from ultra-processed foods, their impact cannot be ignored.

Aside from the implications these findings have on managing and treating a range of health conditions; we also need to be careful that as a result of the study our judgement isn’t adversely swayed against all potential time saving health pathways. For example, the more seamless we can make the patient experience from initial appointment booking to treatment and discharge the better the outcome for individuals and health services alike. So, making the best use of technology to relieve us from routine tasks might sound too good to be true but a well set-up technological solution could help to free up precious time.   

Or take a recent NHS trial which reported at the end of February for example. The trial looked to replace the traditional endoscopy procedure to identify the condition ‘Barrett’s oesophagus’ with a simple ‘sponge on a string’ approach. Over 8,500 patients took part in the trial with nearly 80% of them being discharged without the need for further testing. Not only did this outcome save staff time and resources, because no sedation was required to carry out the procedure, patients had a far more positive response to it.

Finally, in a spirit of moderation in all things we shouldn’t see the ultra-processed foods report as a call to ban all such foodstuffs from our daily lives. In September 2023 the NIHR School for Public Health Research commented that the ultra-processed food category “also includes foods that are affordable, accessible and nutritious” giving the example of supermarket bread which has been made with wholegrain fortified flour. They also counselled against a knee-jerk reaction, recommending that more research was undertaken in order to avoid an unhealthy food-shaming outcome.

The launch of the NHS’s Pharmacy First scheme on 31^st January 2024 has been heralded as a potential game changer for patient care. By enabling community pharmacies to prescribe and treat seven common ailments* it is hoped that the Pharmacy First scheme will enhance care options whilst freeing up GP time. So much so that with more than 10,000 pharmacies having signed up to the new scheme, the expectation is that if the scheme is a success it could lead to the freeing up of some ten million GP appointments each year.

Commenting on the Pharmacy First scheme David Webb, Chief Pharmaceutical Officer for England, said: “Pharmacy teams play a very important role in the community as part of the integrated NHS primary care team, and this expansion of clinical services means patients will have more choice in accessing the care they need. This will give people more convenient options at the heart of local communities, without needing to book an appointment.” Meanwhile the Chair of the Royal Pharmaceutical Society in England, Ms Tase Oputu, commented that: “Pharmacy First is a leap forward in improving patient care” adding that the scheme not only “empowers patients with greater choice on where and how they receive care, but also makes the most of the valuable skills of pharmacists and their teams.” 

Louise Ansari, Chief Executive, Healthwatch England, also highlighted the potential benefits to be gained from greater flexibility but went on to caution that it will “take time for pharmacists to get trained and ready for change.” This is key to the success of the Pharmacy First scheme which is dependent on having enough trained pharmacists to meet public need.

If the idea of walk-in appointments and one-to-one consultations with a pharmacist catches on, then there is an acknowledged danger that demand will outstrip supply.  Particularly so as pharmacies are already offering a blood pressure check service and contraception services. This increased demand on pharmaceutical time could lead to patients turning back to GP services for pharmacy-treatable conditions if they experience long waits at their local pharmacy.

Nevertheless, the Pharmacy First initiative is yet another example of the way in which health approaches are broadening away from the ‘traditional’ GP led model and towards a more flexible offering. With patients being able to access the most appropriate treatment model for them the future could see direct approaches to a broad spectrum of health and social care providers. If individuals are able to see pharmacists for minor ailments, physiotherapists or osteopaths for musculoskeletal conditions, counsellors for mental health conditions, and so on then it could help them to take control of and better manage their health journey.

Spreading out health treatments in this way does though rely on the maintenance of a unified health record. Being able to scan and share patient notes could help clinicians to have a better grasp of the overall picture and to ensure that treatments offered are appropriate within an overall care plan.

* The seven ailments covered by the Pharmacy First Scheme are: Sinusitis, Sore Throat, Earache, Infected Insect Bites, Impetigo, Shingles, Uncomplicated urinary tract infections in women.

At the time of writing the new year is nearly a week old and already we are starting to see a bit of a change. Not necessarily as a result of new year resolutions which can take far more than a few days to take hold. The more immediate change seen is that the incessant storms and rain of the past couple of months seem at last to be giving way to a spell of clearer but colder weather. And with that change comes increased challenges for health services, with slips and falls on icy surfaces increasing the burden on fracture and physiotherapy clinics.

Weather aside, what about those new year resolutions; how are they holding up? Interestingly this year a casual glance at the media gives the impression that the usual call to lose weight, get fit and so on is tempered by a realisation that grand gestures made as one year turns into the next are virtually doomed to failure. Instead, it is the small changes to attitude and lifestyle which have a far greater chance of succeeding.

For example, resolving to walk 10,000 steps a day might seem like a simple challenge; but the first day that you fall short of your goal can lead to the resolution being cast aside. On the other hand, a resolve to walk a bit more, perhaps to take the stairs rather than the lift, or to park at the far side of the supermarket car park, can make a measurable difference to step count. This writer even found that walking back and forward to the cupboards with a few dishes at a time rather than carrying as many as possible after washing up made a surprising difference to overall step count. And by introducing these small steps into a daily routine, it can be easier to succeed in changing habits for the long term rather than crumbling under the huge burden of an impossible task.

That same approach can also be applied to our working lives; both in helping our health practices to operate more smoothly and helping patients to optimise their treatment times. Even something as simple as an appointment reminder sent via SMS text can make a difference. Life can be crowded and an appointment reminder could help to job the memory; as a result, either helping to ensure an individual attends on time, cancels, or rebooks their appointment, thereby freeing up the slot for someone else.

So a simple step such as this, programmed into the appointment booking system, can help both patients and practices. Other simple steps could also result in a smoother experience. How about offering clients the opportunity to book online? It might not suit everyone but could help some people to make a booking as soon as they perceive a need rather than having to wait until the practice is open and answering calls at which time they themselves might not have the time to call.

Here again, a simple change now could have measurable results in the long term. That is perhaps why the message about promoting a ‘new you’ for 2024 says that it doesn’t always require a complete makeover. Sometimes small steps can lead to big changes.

Is Artificial Intelligence (AI) acting as a catalyst for giant leaps in health delivery? Hardly a day goes by without one news story or another extolling the virtue of AI. For example, at the time of writing a quick search of articles issued in the preceding few days brings up an article in Forbes on “Generative AI: The next frontier in healthcare” and in The Parliament magazine on “How artificial intelligence is revolutionising healthcare.”

The use of AI as a transformative factor in health care has long been predicted although perhaps only now are we getting to grips with its potential. Indeed, an article in Science Direct in 1992 commented that three key factors were preventing AI from delivering its potential. These were “physician disinterest; the low priority assigned to Al among healthcare information systems executives; and the relatively new competitive market pressures affecting health services delivery.”

Perhaps at that time we were unable to fully comprehend the AI potential. But nowadays that reluctance is long gone with a 2019 future healthcare journal article commenting that AI “technologies have the potential to transform many aspects of patient care, as well as administrative processes within provider, payer and pharmaceutical organisations.”

Important as those giant leaps are, we should not lose sight of the fact that most revolutions are made up of a mixture of big steps and little ones and that those smaller steps can play a vital role in delivering change. Nor should we let our excitement at the use of new technologies blind us to the fact that patient delivery sits at the heart of health care. And what that means is that it is vital that health providers take every chance to help people to embrace technological change.

This is where some of the ‘small steps’ can play their part. Digitising client records may seem like a very small step in the overall scheme of things but it could open up the way for an enhanced patient/ health practice partnership. So the news that over 80% of GP practices have given their patients online access to their records is encouraging. According to NHS data, as a result in October 2023 more than nine million people viewed their records through the NHS App. This has led to a reduction in patients having to contact their practice for routine interactions such as viewing test results, making an appointment, or ordering repeat prescriptions.

The more that people become comfortable with digital interactions, the greater the potential for the benefits to be spread more widely across all health practices. On line patient data can help multiple agencies to view records more quickly than before. And when people feel comfortable with online appointment booking, practices can save on administration time.

Of course, there will still be times when people would prefer to speak to their health provider on the phone. For those times, the ability to switch phone calls to a dedicated virtual assistant service can be invaluable to a health practice; enabling it to concentrate on patient delivery whilst providing a personal service which their patients might need.

AI driven health care is here to stay. But as we are making digital strides forward we should not forget the importance of putting people at the heart of delivery.

We’d like to think that there is a pattern, a rhythm to life which enables us to make the most of our work and free time. When it comes to health services, boosted by efficient planning and the best use of technological systems, that rhythm should enable great patient outcomes whilst making the best use of staff time skills, and resources.

Even a simple system such as an online appointment booking service can help in this regard. Online booking can enable individuals to log on and make appointments at a time to suit them, even out of hours; whilst SMS text reminders help to improve patient attendance levels. All without taking too much administration time out of a health practice’s day.

However, life doesn’t always run as smoothly as we would like and events come along which can disrupt the working pattern. Some we can plan for. For example, the period around bonfire night is likely to see a greater call on health services which deal with the aftermath of bonfire party accidents. So much so that the NHS website reported a 27% increase in searches about burns and scalds over the bonfire weekend when compared to the average. That represents a search every twenty-one seconds.

Commenting on this increased call on resources Dame Ruth May, Chief Nursing Officer for England, said: “We see a significant increase in visits to the burns page on the NHS website over the weekend of Bonfire Night and we’d encourage people to follow RoSPA’s advice on firework safety to stay out of harm’s way.”

Other health pressures can be more weather dependant. Here, some pressures can be predicted whilst others are more random. So the start of the annual skiing season is likely to lead to a rise in calls on physiotherapy and fracture clinic times. That largely follows an annual pattern. But other weather events such as storms, heatwaves, or the onset of icy weather are less predictable.

Meeting these challenges requires efficient planning systems to have an element of inbuilt flexibility. Weather forecasters may only be able to give us a few days’ notice of extreme events, leaving health practices having to respond rapidly to changing situations. As with any crisis management plan, communication is key. Being able to quickly advise patients, staff, and external contacts of the nature of the challenge and the steps being taken to meet it will help people to play their part. Here again SMS text messaging could help both in spreading the initial message and providing updates.

Another option could be to adopt the use of an external clinical call handling service such as that provided by Clinic Appointments. Being able to outsource call handling, message taking, dealing with simple queries, and appointment management can help to free up time which would better be used within the health practice. And whilst the service is available on a full-time basis, the option to use the service as and when needed provides health practices with the ability to outsource call handling in busy periods and then bring calls back in house at quieter times.

Who, What, When, Where, Why, hoW. These six ‘w’ questions lie at the heart of so much of our lives. And when it comes to our health and health management, having accurate and informative answers to those questions could make the difference between the delivery of successful treatment plans and an ongoing health emergency.

It would be nice to say that thankfully the days of following paper trails are over; with smart data now delivering seamless and instantaneous transfers of information across health systems. However, the recent story of thousands of letters stuck in a hospital electronic file shows that there is still some way to go before we achieve smart data sharing.

Nevertheless, electronic systems have improved and are improving to the benefit of patients. Even the ability to electronically store patient notes has helped to speed up referral and review processes. This writer remembers only too well in the past a relative being handed copies of notes and x-rays to store at home and take to their appointment elsewhere the following week. They were told that otherwise the records would have to be posted and that could lead to delays of up to a month!

So digitising records is an improvement. But with so much patient data going online, what safeguards should be put in place to ensure that patient safety and confidentiality is maintained. That’s a question which will be put to members of the public in a series of events in 2024. Designed to take the next step in digital transformation, the events will both showcase existing programmes and ask people to have their say in the shaping of future digital policies.

Commenting on the initiative Dr Vin Diwakar, National Director of Transformation at NHS England said that: “Better use of data brings huge benefits for patients, ensuring more joined-up care and better use of NHS resources, and leading to faster cancer diagnosis, shorter wait times for elective operations and reduced stays in hospital.”

However, they went on to acknowledge that public support is integral to how data is used to improve care. This comment was echoed by Nicola Hamilton, Head of Understanding Patient Data who said that large scale engagement events are “urgently needed to ensure the public has a greater voice in how their data is used, what choices they have, and what safeguards they feel are necessary to improve potential benefits and reduce potential harms.”

One of the dangers with data is that the possession of information is seen as an end point rather that a stepping stone to understanding and delivery. That’s where integrated health care programmes come into their own. It might be something as simple as the provision of wearable digital devices which monitor patients in their own homes; thereby freeing up hospital beds. Or it might be the electronic sharing of patient records to enable cross-healthcare and welfare treatments for individuals with multiple conditions. Whatever the solution, the key to personalised treatment plans lies in the accurate and fast sharing of digital patient information.