In all the places I have seen an ability to try something radical and new in the sphere of health and social care (Valencia and Arkansas being two prime examples), I have witnessed one key component. They have fixed the IT! It is really not beyond the wit of man, though I accept it is not altogether straightforward. However without it, change is painfully slow and it is extremely difficult to make the kind of changes we need to see. I do not understand why the Government will not invest in this area appropriately. Here in Morecambe Bay we need to crack this nut if we’re going to be able to let go of our past and embrace a truly collaborative and integrated way of working.
The benefits to everybody would be huge. Patients would have safer, more streamlined and ultimately more affordable care. This would cut the complaint and litigation culture to an absolute minimum. Clinicians would be able to work far more collaboratively, effectively, safely and efficiently. If we allow ourselves to imagine just what a difference it could make then we will act to make this a reality.
There have been some great strides forward made here by the excellent work of GPs like Tim Reynard and George Dingle, who are developing some fantastic new ways of working and building relationships between primary and secondary care. But their efforts are being hampered by a lack of a truly integrated system.
As just one example, take the referral process. If a patient comes to me asking for a referral, which may also require some complex tests to help reach a diagnosis, currently there is so much wasted time and effort plus duplication of work that it is an absolute farce. Say someone comes to see me with a suspected rheumatological condition. Currently, I can see them, assess them, order some (but not all tests) and then refer them. My notes will be on my computer system, but my letter to the consultant may not fully convey all the intricacies of the history I have taken over weeks. My letter has to be written and sent off (on occasion they get lost in the system, causing huge frustration to the patient). Then the consultant sees them……..she will probably order further tests, which she will then write to me to organise, or have them done at the hospital, then she will see the patient again. She will then start some treatment, but will write to me to prescribe it and then the patient will then come to collect it from my surgery. She also asks me to refer onto our community physio teams (a letter I read at 7pm after 11 hours of non-stop work, when I want to get home for my kids’ bedtime stories). There are several points of frustration for everybody involved in the process, not least the patient with wasted time and resources along the way (plus extra letters to answer complaints for missed referrals or whatever else might go wrong).
In an integrated system, the patient sees me. I write good and detailed notes, which I link to the consultant rheumatologist, assigned to work alongside my practice, with a short note attached. She then liaises with me in a straightforward way about the case, decides what extra tests are required and these are organised (within appropriate resource allocation) ahead of the consultation. The consultant sees the patient, with a full history and set of investigations. She agrees a treatment course with the patient, prescribes the necessary drugs, which automatically appear in the electronic record, so my team can print out the prescription and the patient can pick it up. She also simultaneously links her consultation to the community physio with a short note and her therapy can be arranged in a slick and easy fashion. This has saved loads of steps, time, energy, complexity and errors. It is a basic example. There are many more areas, like maternity care, patients with complex medical problems involving the care of multiple departments etc where this is simply a no brainer.
So what is stopping us? Actually it’s pretty straight forward. 1) A lack of sensible and adequate resourcing from the government within the Vanguard system, which would allow us to make significant changes in a small amount of time. Instead of concentrating on a few Vanguard sites and allowing us to really flourish, things have become far too watered down across way too many experimental initiatives and the funding promised has not been made available. This really needs to be rectified. I’m sure there are things we could also streamline within our Accountable Care System. 2) Stupid competition laws and sweeteners offered to some of our partner providers to use certain IT systems which are clunky and unfriendly when it comes to creating platforms that can talk to each other, have slowed us down. We need a focused and joined-up approach. 3) Priorities. My argument is that without integrating the IT fully and investing in front end smart IT that promotes self care and more appropriate use of resources, we will not achieve together what we could in a way that will benefit everybody.
In short, we need to fix the IT. It is the solution to a vast majority of our problems and will allow us to really have Better Care Together.