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Pharmacy First

The launch of the NHS’s Pharmacy First scheme on 31st 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.

New year, new you

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.

AI driven health care

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.

Planning for the unexpected

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.

Integrating digital health care

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.

Making or changing appointments

What is the number one priority for your website? Would you be surprised to find it is the ability to make, change or cancel appointments? That’s according to NHS England whose advice on creating a ‘highly usable and accessible GP website’ was recently updated in August 2023.

With 62% of individuals visiting their GP’s website in 2022, it is easy to see why having a clear and easily understood website might benefit not only patients but also the health practice. And as NHS England point out, health sites have to cater not only for those who are fairly computer literate but also for those with moderate to low digital confidence, those with lower levels of literacy, those for whom English is a second language, or those who may be dependant on using accessibility software and tools.

As such the advice given on setting out GP websites may also be pertinent to all of those working in the health and health related sectors. With websites increasingly becoming the portal between patient and health practice, prioritising the patient journey comes at the top of the list. But so too does an emphasis on maintaining the site; creating clear, accurate, and concise content which is updated regularly.

However, that need for regular updating shouldn’t come at the cost of patient confidence in the system. Providing up to date relevant information can help to direct individuals to the service which best meets their needs. Moving that information around the site or creating differing access points can lead to confusion initially and eventually can engender a lack of trust in the service. And remember, websites can look and behave differently on mobile or computer so ensure that they are fully tested across different screen types before going live.

Admittedly, there will be times when individuals may choose to speak to an individual rather than accessing the website. For those times, it is important that help can be accessed quickly rather than having to hang on the phone hoping for an answer. That can cause problems for some health practices which may not be able to respond as they would wish due to existing staff/patient interactions. For those practices, having a back up phone answering service might be the answer.

Clinic Appointments offers that back-up support. With a team of professional receptionists, Clinic Appointments specialises in providing phone support to the healthcare sector. From single practitioners to multi-site clinics, we provide flexible and scalable telephone answering and diary management support. Calls are answered in the name of the health practice, providing peace of mind to callers that they are speaking with someone who will understand their query. And the flexible nature of our support packages means that practices can opt for full time telephone answering support or switch phones over when required.

Apart from telephone answering, practices which are looking for a robust appointment booking system might decide to adopt our in-house diary system. An appointment reminder service is also available; sending reminders via SMS text or email.

Stepping up to health

Good news! Those who to date have struggled to reach the magic goal of ten thousand steps a day can now gain some comfort from a study which revealed that even four thousand steps can make a difference. The study, which was published in the European Journal of Preventative Cardiology, aimed to build on previous studies which had established the link between inactivity and ill health, in particular heart disease. This study looked to take knowledge one step further and identify the relationship between daily step count and all-cause mortality and cardio-vascular mortality.

However, we ditch our step counters and sit down for a rest the study does come with a sting in the tail. Although 2,337 steps per day have been revealed to be the cut off for cardio-vascular mortality and 3,967 steps for all-cause mortality, these are only the baseline figures. Above those figures the study reveals that there is a 15% reduction in the chance of early death for every additional thousand steps, up to twenty-thousand per day. So the fewer steps we walk, the more we are playing with our longevity chances.

The dangers of physical inactivity have been highlighted by the World Health Organisation which cites inactivity as the fourth leading cause of early deaths worldwide; accounting for some 3.2 million deaths per year. Little wonder then that one of the study’s authors, Prof Maciej Banach from Lodz University commented that whilst drug and other treatments have advanced, he believes we should: “always emphasise that lifestyle changes, including diet and exercise, which was a main hero of our analysis, might be at least as, or even more, effective in reducing cardiovascular risk and prolonging lives.”

It’s an area in which as health professionals we can all play our part. From physiotherapists helping people to regain mobility as swiftly as possible following injury or operations to health and social workers actively finding a way for people to move out of bed blocking and into a more active community setting; the more that people can be helped and encouraged to increase their step count, the better the outcome. For a stretched health service that extra push towards mobility means finding ways to work smarter rather than harder, to increase patient interactions without having to increase working hours.

Technology may provide some of the answers. From online appointment systems to SMS appointment reminders and from digitising patient notes to outsourcing routine enquiries; every time that we can harness technology to reduce administration time brings the chance to smooth out the working day and enhance patient interactions.

We have to acknowledge that ten thousand steps may be beyond some individuals no matter how much medical intervention they get. But if we can help even a little then that could make a measurable difference. After all, even a walk to the toilet or to the kitchen to make a cup of tea could contribute to the lower target of 2,337 steps which according to the new study marks the boundary between inactivity and beneficial exercise.

Understanding data: Improving health outcomes

Measure this, record that, track those changes: sometimes it can seem as though our lives are ruled by data. But as everyone in the healthcare sector knows, those individual data points can make a measurable difference to patient diagnosis and outcomes. That’s why digitising patient records is so important, enabling us to quickly share findings and to look back at previous records. That blip in the record six months ago or longer might just help to pinpoint the progress of a disease.

With data in mind, it was interesting to see three key reports hit the headlines in recent weeks. The first, published on 23rd May, set out statutory guidance for the protection of patient data in England. Arising from the transfer of patient data from NHS Digital to NHS England, the regulations have been drawn up to “ensure that NHS England acts as a safe and effective guardian of people’s data collected from NHS and adult social care services.” Key to this safeguarding is the protection of any data which can either identify an individual or, if de-identified could be re-identified or traced back to an individual.

The importance of anonymising data also runs through the Health Survey for England. This survey aims to identify health and lifestyle trends by interviewing individuals chosen at random across the country followed, in some cases, by a visit from a biomedical fieldworker. Due to low levels of participation the current 2022 survey has been extended with interviews expected to continue until summer 2023 with follow-up visits continuing into the autumn.

In the past this survey has identified a lack of public awareness of key health areas such as high blood pressure and kidney disease. This has resulted in a change of approach in respect of these conditions by raising awareness and increasing testing. It also helps to track changes in health and lifestyles as well as enabling more targeted planning of health and social services.

Having data is one thing, being able to optimise its interpretation is quite another. That’s why a new review into the UK’s health data could prove to be so significant. Launched on 31st May 2023, the review: ‘Uniting Health Data in the UK’, aims to map and assess the flows of health-relevant data across the UK.

Led by Professor Cathie Sudlow OBE, Chief Scientist at Health Data Research UK (HDR UK), the independent review aims to map the health-relevant data landscape across the UK as well as identifying barriers to its use. It will also recommend potential solutions for better data management. Along the way it will consult with a wide range of organisations and individuals with the intention in particular of actively involving patient groups.

Commenting on the review Professor Sudlow said: ““This is an exciting time to be involved in health data, but we are still a long way from maximising its potential for benefiting patient care and the public’s health. This review provides an opportunity to chart the course for a new era in health data, mapping existing strengths and identifying ways that our approaches could be improved.” 

Community rehabilitation

When we talk about the National Health Service it is all too easy to think of some large and impersonal entity. But talk to any individual and they are far more likely to talk about ‘my doctor,’ ‘my local hospital,’ ‘my physiotherapist.’ And that quasi-one-to-one relationship sits at the heart of delivering effective healthcare.

The need for a more personalised local response runs strongly through the Chartered Society of Physiotherapy’s (CSP) community rehabilitation plan. First launched in October 2022, the plan has hit the headlines more recently with a version being launched in Northern Ireland at the beginning of May 2023. The plan opens with a simple statement:  

Rehabilitation makes people’s lives better. Many of those who would most benefit from rehabilitation, however, face barriers to accessing services.”

Those barriers can lead people to come back time and time again to require core NHS services rather than being supported in a more appropriate way. For some individuals that support may come from Social Services, whilst others may be better helped vial community hospitals or care homes, or through the provision of physiotherapy, occupational therapy or other interventions.

Importantly, delivering community rehabilitation in this way not only reduces the demand for NHS in-patient services but also can improve the lives of individuals; helping them to live with, manage, or improve their conditions. But for community rehabilitation to work the CSP recommends that it is delivered as an integral part of an integrated care system (ICS) which looks to “include primary, secondary, tertiary health care, mental health, social care, independent and third sector providers.” 

Underpinning the delivery of an effective community rehabilitation plan, the CSP recommends that:

  • Referral processes are explicit, easy, efficient and equitable
  • Rehabilitation interventions are timely, co-ordinated and prevent avoidable disability
  • Rehabilitation interventions meet patient needs and are delivered in an appropriate format
  • Rehabilitation pathways should meet needs and be delivered locally with access to specialist services
  • Rehabilitation Programmes should enable optimisation, self-management and review
  • Rehabilitation services are well led, adequately resourced and networked to other services
  • Rehabilitation Services involve Families

That desire to involve families and local providers in the delivery of coordinated rehabilitation demonstrates the importance of localised and personal health delivery which is tailored to the individual. Importantly it also draws in all providers of health services into an integrated patient-centric network. It’s one reason why the use of technology is revolutionising health delivery. Even something as simple as the ability to digitise patient notes helps with the sharing of information across organisations. This not only helps to speed up referrals but also to provide a more targeted treatment plan, particularly in those who may need multi-disciplinary treatments.

At the Northern Ireland launch of the community rehabilitation plan Marie-Therse McDonald, CSP professional adviser for Northern Ireland said: “Without access to high quality community-based rehab, people will continue to be driven towards the most expensive parts of the health and social care system.” She went on to add “We know that what tends to work is care close to home, person centred, specialist, integrated and supports self-management principles.’”

Integrating care

“Integrated care systems (ICSs) represent the best opportunity in a generation for a transformation in our health and care system.”

The executive summary from The Rt Hon Patricia Hewitt’s review into integrated care systems leads with that bold vision of the future of health provision within the UK. However, the subsequent sentences carry a warning to the effect that effective change will require new structures and changed cultures in which “everyone needs to change, and everyone needs to play their part.”

With local government, social care providers, community and other organisations all linking together with NHS services; integrated care systems are designed to improve the lives of local people; helping them to live healthy and independent lives through the provision of support at the point of need. With so many organisations all coming together to provide that support, there is though a danger that silo practices or too narrow a focus on delivery could get in the way of the project.

That is why the review was so important; identifying best practices and potential points of failure. To that end, the review has identified six key areas which will need to be addressed in order to deliver thriving integrated care systems. These are:

  • collaboration within and between systems and national bodies;
  • a limited number of shared priorities;
  • allowing local leaders the space and time to lead;
  • the right support;
  • balancing freedom with accountability; and
  • enabling access to timely, transparent and high-quality data.

That last area of focus has also highlighted the importance of the use of data and data management which is relevant and timely. One of the conclusions of the report is that an excessive focus on targets can in fact lead to poorer patient outcomes. That is because leaders are focused more on ‘gaming the system’ in order to meet targets rather than in finding ways to provide viable treatment plans for individuals. Accordingly the report recommends that there be a significant cut in the number of national targets with integrated care systems instead introducing a suite of priorities based on local need.

The report also strongly promotes the provision of integrated approaches which look towards holistic healthcare and prevention. Commenting that ‘for too long we have mistaken NHS policy for healthcare policy’ the report cites an initiative which looked to support physical activity and address social isolation in Wigan. So successful was this community-led initiative that it resulted in a seven-year increase in life expectancy in the most deprived wards in Wigan. It’s an example of the way in which a simple step outside of core health provision can result in a significant improvement in health outcomes.

Commenting on the report the Chair of the Health and Social Care Committee Steve Brine MP said: 

“This is a key moment for Ministers and for NHS England. We have found genuine enthusiasm for the potential of Integrated Care Systems to make a real change, not only in how health and social care is delivered but in prioritising the needs of local populations and preventing ill-health.”

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