Author: Alison Griffiths

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.

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.

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.” 

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.’”

“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.”

The news that nine percent more deaths were recorded in 2022 than in 2019 (the last year before the pandemic) has naturally given rise to a fair amount of debate. It may well be that we have to wait for the results of in depth studies before we see a more definitive indication of the causes of excess mortalities. In the meantime, various theories have been put forward as to why the second half of 2022 in particular saw more deaths than would otherwise be expected.

During the course of the pandemic, concerns were raised that patients were delaying approaching their doctors or finding it difficult to receive an accurate diagnosis when consultations were managed at a distance. It was therefore recognised that the potential for untreated conditions to require greater intervention, once diagnosed, than would otherwise be the case could lead to excess deaths. For example, a recent BBC report, highlighted a reduction in the number of new prescriptions for blood pressure medication or statins during the covid period.

The ongoing effect of having had covid has also been put forward as another potential reason for people dying earlier than expected. One study reported in the BMJ [1] concluded that “Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population.” This includes an increased risk of cardiovascular disease following covid infection.

This theory is bolstered by another BMJ report [2] which highlighted the fact that whilst an analysis of the ‘underlying cause of death’ for conditions such as heart disease and stroke have not shown an increase, this changes dramatically when looking at the wider causes of death mentioned on death certificates. In particular, death certificates mentioning cardiovascular disease and diabetes have been seen to be substantially in excess of the norm since April 2022.

The ongoing pressures on the health service have also been put forward as a potential reason for some excess deaths. From delays in seeing a GP and starting treatment to pressures on the ambulance and emergency services; it is inevitable that pressures on the health service have the potential to affect patient outcomes.

This is one reason why there is an increasing emphasis on the part played by pharmacists and other health practitioners in delivering healthcare solutions. The more that healthcare professionals across the board can contribute to delivering patient outcomes, the greater the potential for improved acute patient outcomes. Of course, that spreading of the burden is only effective if it can be done without over-stressing other elements of the healthcare service. In part that means finding ways to work smarter rather than harder, to optimise patient consultation times without adversely affecting patient care.

Strategies such as digitising patient records can help here, enabling patient notes to be shared across healthcare professionals as required. Not only does this reduce delays in referrals, it also avoids needless time spent in requiring the patient to repeat their history to each successive healthcare professional. 

The problem of excess deaths isn’t confined to the UK. Speaking to Sky, NHS England chief strategy officer Chris Hopson highlighted that countries such as Germany, Spain and Italy are also experiencing higher mortality rates than normal. That’s why further research is required to identify the underlying factors and put mitigation strategies in place. Pending that research, the more that can be done to spread the excess healthcare workload, the better.

[1] https://www.bmj.com/content/372/bmj.n693

[2] https://www.bmj.com/content/379/bmj.o2524

“When health as a fundamental human right is upheld by all countries and all sectors, we lay a strong foundation for building the world we all want and deserve.”

That quote from the World Health Organisation (WHO) perfectly illustrates why in 2017 it decided to launch International Universal Health Coverage Day. The day, which is held on 12^th December each year, aims to showcase international efforts to prioritise health care for all people, communities and organisations across the world.

The theme for 2022 is: “Build the world we want: A healthy future for all.” According to the WHO primary health care which is based on a ‘whole of society’ approach is the most effective way to bring health and well-being closer to people. Accordingly, the WHO is calling for societies and economies to be designed to prioritise everyone’s health.

The WHO comments that improvements have been made in the delivery of universal healthcare since it first started to promote the idea of health care for all some seventy-five years ago. However, the WHO also acknowledges that inequalities in service coverage and financial hardship still exist in many countries, especially among vulnerable and hard to reach populations.

This year’s event is overshadowed by the impact which the Covid pandemic had on universal healthcare with the effects having been exacerbated by the current global economic recession. These, the WHO say are likely to halt progress seen in recent times, particularly among disadvantaged populations.

Even in a country such as the UK which, thanks to the NHS, has had a primary healthcare system since 1948 we have seen the effects of Covid on healthcare delivery. The combination of delayed treatments and the ongoing health impacts of those affected by long covid have helped to put the service under even more strain than before.

But universal health provision is not simply a matter of treating existing conditions. Prevention too plays an important part. Take the Chief Medical Officer’s recent call for the UK to do more to reduce air pollution. Recognising the progress which has been made towards tackling outdoor air pollution, Professor Chris Whitty comments that we should not ignore the impact which indoor air pollution can have on health.

We spend around 80% of our time indoors and yet indoor air pollution is still in many instances not seen as a priority in designing and managing buildings; particularly public spaces. In order to address this the Chief Medical Officer has called for work to be undertaken to find ways of ensuring effective ventilation in indoor spaces whilst minimising energy use and heat loss. Research, the CMO says, should also look at ways of reducing indoor air pollution including reducing the sources of that pollution.

Taken together indoor and outdoor air pollution have been linked with a range of health conditions including lung cancer, cardiovascular problems and asthma. It’s a perfect illustration of why the WHO sees health provision in terms of societies and economies; with every agency uniting to deliver health coverage for all.

As we slide past the middle of November we have to admit that, so far, autumn has been a fairly mild affair. So much so that Armistice Day 2022 was the warmest on record. Is this warm autumn going to continue or should we be preparing for storms ahead?

According to the Met Office’s long range forecast it’s a bit of a good news, bad news scenario. On the positive side, although the Met office doesn’t rule out the chance of stormy weather at times, they say that the risk of strong winds and storms is less than normal. However, whilst we may see fewer strong gales than in recent years, the risk of excess rainfall is being supplanted by a greater chance of a colder winter.

If the Met Office is right, that means more frost and ice. And if that happens then potentially there will be an increasing demand on health services as pedestrians slip and fall and traffic slides in the icy conditions. And it’s not just physical health which can be affected; with a Met Office survey released in October 2022 revealing that 41% felt their mental health was affected by winter weather.

Planning for such eventualities means finding ways to deliver continuing care without unnecessarily tying up vital resources. Truth be told, at the time of writing there is no way to be certain when this colder weather will arrive. As the Met Office’s Chief Meteorologist, Professor Paul Davies, commented “the science, as yet does not allow for specific detail on, for example, the number of nights of frost, rain or snow over the coming months or when specifically severe weather may occur.” 

That can make planning difficult. How do you agree holiday leave or structure shifts based on likely demand/resource matrices if you don’t know when that demand is likely to occur? And is it really the best use of scares resources to take on extra staff just in case they might be needed when poor weather hits?

One solution could be to develop processes which can be flexed as demand requires. For example, a health practice might decide to appoint a call answering service such as that provided by Clinic Appointments. Available either on a permanent or ‘at need’ basis; having calls answered by an external agency helps to relieve administration burdens, particularly when resources may be stretched. With calls answered in the name of the health practice, clients need not know that you have outsourced the call function.

Our call handlers can screen out unwanted sales calls and answer general enquiries leaving you free to concentrate on patient treatments. Add in the diary management option and we can also book and update appointments as well as send out appointment reminders if required. Over 97% of calls are answered within three rings, providing a professional response for health patients.

Best of all with the option of an overflow or permanent services, health practices have a potential call management solution which can flex as the needs of the business change in response to the weather or to any other factor. The Met Office may not be predicting storms this winter but flexible planning solutions could help health practices to weather any other seasonal pressures that this winter may bring.

Last month we wrote about a campaign to reduce the stresses which health practitioners encounter on a daily basis. In our article we highlighted a few coping strategies suggested by the BMA. And we looked at how even simple administration changes such as sending out appointment reminders by SMS text or taking credit card details at the time of booking could help to reduce the number of missed appointments; a potential source of stress for practitioners and patients alike.

There is another reason why something as simple as SMS text reminders could make a marked difference to some individuals; the menopause. Whilst every individual’s experience of the menopause is personal to them, cognitive difficulties are relatively common. So much so that research conducted for World Menopause Day on 18^th October by the Chartered Institute of Personnel and Development (CIPD) revealed that nearly two thirds of women who were experiencing menopause symptoms found they were less able to concentrate. No wonder therefore that the theme for the 2022 day is ‘cognition and mood.’

A paper released by the International Menopause Society highlighted some of the cognitive difficulties experienced by those transitioning menopause including disturbances in daily life, trouble concentrating, and forgetting appointments and events. With that in mind, even something as simple as SMS text reminders can make it easier for individuals to manage their daily lives without missing out on important health checks. From this writer’s personal experience, another source of stress is the fear that appointments have been written down incorrectly. This has led to a need to phone the health practitioner to double check, something which could have been avoided had SMS texts been issued.

This leads us on to another important issue, the effect which the menopause could have not just to patients but also to those working within health practices. The CIPD research mentioned above also revealed that sixty percent of those surveyed found that menopause symptoms had a negative impact on their work. When everyday actions can seem stressful, the more that processes can be automated the better. For example, digitising patient records might seem like a simple solution. But being able to retrieve information at the touch of a button rather than searching through paper files can help to relieve stress; particularly if there is a concern that ‘brain fog’ might have led to mis-filed information. Solutions such as these may go some way  towards helping the more than 50% of people who reported increased stress levels during the menopause.

Finally, it is important to be clear that every individual’s journey will be personal to them and that symptoms may come and go over time. The effect on friends, family, and colleagues cannot be underestimated. As the NHS employer’s website commented: “Menopause is not just a gender or age issue; it is an organisational issue.  It can impact on colleagues both directly or indirectly. Awareness on this topic is fundamental and reducing the stigma attached to it is vital so that more people will talk openly about it so it can begin to be normalised and people can get the support they need.”