Online consultations: disrupting rather than destabilising
In primary care, GPs are under increasing pressure as numbers decline while the population grows, along with the complexity of cases. It’s clear that change is absolutely necessary; the future of primary care must be technology enabled.
In November 2017, NHS England launched a £45mn fund to contribute towards the costs for GP online consultation systems, as part of NHS England’s GP Forward View. This money will be split over three years, giving CCGs an annual budget of £15mn. Divide this number by the UK’s 58mn registered GP patients and you get a figure of 26p per patient per annum. This might not sound like much but with the most basic services available for as low as 2p per patient per annum, this fund could revolutionise the delivery of primary care.
Appetite for disruption
We’ve already seen that there is a huge appetite for disruptive technology in GP practices. Usually involving a website or app, online consultations increasingly serve as the first point of contact between a patient and a GP, improving patient access to care and making best use of clinicians’ time.
While there has been controversy surrounding GP at Hand, the free NHS service powered by Babylon, the model has demonstrated the desire for digital-first services from both patients and forward-thinking GPs. In its first seven months, a staggering 40,000 London based patients applied and 200 GPs signed up to the service.
Patients were drawn in by the speed with which they could book appointments (an average 38 minutes) compared to waiting a week or more in traditional practices and the potential to get a same or next day face-to-face appointment with a GP in one of five London clinics.
So far so good but, unfortunately, there’s a flipside; by signing up to GP at Hand, patients were automatically deregistered from their GP practices. And, because Babylon set a stringent set of rules around the patients it would accept, i.e. no long-term conditions, no mental health or pregnancies, they were accused of ‘cherry picking.’
When the ‘worried well’ moved over to the service, GPs were left with only the most complex and challenging cases. Because of the way funding is allocated, as registration numbers declined, this model destabilised rather than disrupted traditional models.
Leave that aside for the moment, and what GP at Hand undoubtedly demonstrates is the appetite for a revolution in the way patients want to access primary care going forward and, moreover, GPs’ willingness to embrace technology to harness new care models. So, with this mind, where do we go from here?
Bridging the gap between disruptive and traditional models
At Refero, we embrace technology that enables new ways of engaging people and connecting them with public services; we firmly believe there is a need to bridge the gap between disruptive technology and the more traditional primary care models by combining the two to deliver the best of both worlds – adding to, rather than taking away from, more established ways of working.
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Ultimately, we believe it’s about arming GPs with the right tools to meet patient needs and improving access to and quality of care. It’s also about driving efficiencies in primary care and easing the growing burden on those at the coal face – the GPs.
Digital all the way…until the virtual door shuts
Today, patients are able to sign up to an online service, send requests to their GP practice such as “do you have my test results?” or “what are your opening hours?”. These non-clinical engagements can be picked up and responded to by a receptionist or administrator. But, the real value comes from the clinical engagements, i.e. the potential for patients to enter their symptoms into an app or web-based portal which, using their demographics, presents back a list of possible ailments (taken from fully ratified and managed NHS information). Patients are then able to click on these links to find out more.
These digital services usually rely on some sort of triage system with red, orange or green flags determining next steps. For example, a green flag might signify a minor ailment and sign-post the patient to a pharmacist for medication, while an orange or red flag would be directed to a practice coordinator to determine whether an appointment is required with a nurse or GP. It really depends upon the individual practice.
However, many online consultation services end there. Because very few platforms on the market today offer virtual appointments, the engagement reverts back to the well-trodden and offline pathway. Take eConsult, for example; it allows patients to submit their symptoms, and offers self-help information, signposting to services, and a symptom checker. But, if an appointment is required, it’s back to the GP practice for a face-to-face consultation. eConsult want to put a stop to unnecessary visits – an admirable cause but, at Refero, we believe there is a vital piece of the jigsaw missing.
We’ve seen that there is a real appetite for virtual appointments in the market. For example, we know that it’s more difficult for older people in care homes to see their GP. Across the board, patients are looking for more agile access to their GPs and many primary care providers are keen to harness the power of technology to drive efficiencies. So, why close the virtual door after initial online engagement?
One platform, multiple uses
We believe the ideal solution is one platform that enables GP practices to pick and choose from a catalogue of services that they might wish to trial or introduce: from messaging and self-help to symptoms checking and consultations (virtual or otherwise), as well as Artificial Intelligence (AI) and analytics.
We like to think of these services as being like a bag of marbles – you could pick up a small one representing basic online engagement or a larger one representing virtual appointments. The key thing is bringing the many services that fall under the umbrella of online consultations together into a single platform, combined with the ability to switch elements on or off according to need.
Joining the dots between primary and secondary care
Patient facing technology is a key part of helping ease the pressure on GP practices but we believe it could and should go above and beyond that to help join the dots between primary and secondary care on the journey towards integrated care.
Today, it’s fair to say that the lines of communication are disjointed. But, looking forward, it is expected that these one to one engagements between patient and GP could become one to many, involving secondary or specialist care providers. This would enable GPs to seek advice and collaborate with healthcare providers outside of their practice. This is a real game changer in the delivery of patient care.
To achieve this, Clinical Commissioning Groups (CCGs) need to take more holistic view when it comes to procuring services. They need to avoid siloed solutions that meet one particular need and instead focus on solutions that can be rolled out regionally, within their Sustainability and Transformation Plan (STP) footprint areas.
C. Light aim to detect Alzheimer's with AI and eye movements
C. Light Technologies, a neurotechnology and AI company based in Boston, has received funding for a pilot study that will assess changes in eye motion during the earliest stage of Alzheimer's, known as mild cognitive impairment.
C. Light Technologies has partnered with the UCSF Memory and Aging Center for this research. As new therapeutics for Alzheimer’s are introduced to the clinic, this UCSF technology has the potential to provide clinicians a better method to measure disease progression, and ultimately therapeutic efficacy, using C. Light’s novel retinal motion technology.
Eye motion has been used for decades to triage brain health, which is why doctors asks you to “follow my finger” when they want to assess whether you have concussion. In more than 30 years of research, studies have revealed that Alzheimer’s disease patients' eye movements are affected by the disease, though to date, these eye movements have only been measured on a larger scale.
C. Light’s research takes the eye movement tests to a microscopic level for earlier assessments. Clinicians can study and measure eye motion on a scale as small as 1/100th the size of a human hair, which can help them monitor a patient’s disease and treat it more effectively.
The tests are also easy to administer. Patients put their chin in a chinrest and focus on a target for 10 seconds. The test does not require eye dilation, and patients are permitted to blink. A very low-level laser light is shown through the pupil and reflects off the patient’s retina, while a sensitive camera records the cellular-level motion in a high-resolution video. This eye motion is then fed into C. Light’s advanced analytical platform.
“C. Light is creating an entirely new data stream about the status of brain health via the eye,” explains Dr. Christy K. Sheehy, co-founder of C. Light. “Our growing databases and accompanying AI can change the way we monitor and treat neurological disease for future generations. Ultimately, we’re working to increase the longevity and quality of life for our loved ones."
At the moment developing therapeutic treatments for the central nervous system is difficult, with success rates of only 8% to go from conception to market. One reason for this is the lack of tools to measure the progression of diseases that impact the nervous system.
Additionally clinical trials can take a decade to come to fruition because the methods used to assess drug efficacy are inefficient. C. Light believe they can change this.
“Before this year, it had been almost 20 years since an Alzheimer’s drug was brought to market" explains Sheehy. "Part of the reason for this very slow progress is that drug developers haven’t had viable biomarkers that they can use to effectively stratify patients and track disease on a fine scale. The ADDF’s investment will allow us to do that."
C. Light has received the investment from the Alzheimer’s Drug Discovery Foundation (ADDF) through its Diagnostics Accelerator, a collaborative research initiative supported by Bill Gates, the Dolby family, and Jeff Bezos among other donors.
C. Light recently completed its second and final seed round raising $500,000, including the ADDF investment, which brings their total seed funding to more than $3 million. Second round seed funders included: ADDF, the Wisconsin River Business Angels, Abraham Investments, LLC and others.
The ADDF’s Diagnostics Accelerator has made previous investments in more than two dozen world-class research programmes to explore blood, ocular, and genetic biomarkers, as well as technology-based biomarkers to identify the early, subtle changes that happen in people with Alzheimer’s.