By looking at how primary care services and organisations in the US are improving the population’s health and the efficacy of healthcare services, we may be able to better the situation on this side of the pond, says the care services minister
Across the developed world, policy makers are grappling with the challenge of how to sustain and improve health and care systems in the face of rising costs and public finances under pressure.
As more people live with multiple long-term complex conditions, all parts of the system are feeling the strain. Hard working GPs face the treadmill of 10-minute appointments, feeling frustrated that they are unable to give the time to patients who really need their attention.
‘Despite the heroic efforts of dedicated staff, too often patient care falls short’
Accident and emergency departments are battling to cope with ever-increasing numbers, ambulances have to queue up waiting to hand over patients, hospitals are often full with large numbers of older people who are frail, and patients are stuck in hospital long after they are ready for discharge because there’s no place for them to go.
Despite the heroic efforts of dedicated staff, too often patient care falls short. The cheap shot of course, is to blame the government – but these pressures have been growing for a long time.
Travelling to the US for a solution seems counterintuitive, yet within that healthcare jungle there are some gems. A community clinic on the outskirts of Seattle provided a glimpse of a better way of doing things, having redesigned the way primary care works. By putting in place systems that free up precious GP time, the patients that really need focused attention can be seen.
‘Through smarter use of IT, patients can book their appointments or order prescriptions via their mobile phone, and can consult their GP by telephone or email’
Through smarter use of IT, patients can book their appointments or order prescriptions via their mobile phone. They also have the option of consulting their GP by telephone or by email – we saw how a third of all patient consultations are by email.
We met the support staff who see the patient on arrival and deal with the preliminaries, such as checking blood pressure, before they see their GP. This helps the GP focus on what their training and skills can really achieve; every professional in the system was maximising their skills and talents.
At the clinic, GPs were working closely with specialists to ensure continuity of care, even when the patient was in hospital. Staff met in huddles each day to discuss priorities and, throughout the clinic, we saw visual displays of their key objectives and how they were performing against them. This included comparisons on performance with other clinics.
The culture in these organisations is one of constant learning, led by clinicians with support from a range of other experts such as process engineers, economists and technologists.
The result of this way of working was patients receiving the care they need to maintain their health. There were fewer crises in care because the clinic was aware of the relative risks of each patient and was tracking their conditions accordingly. A&E admissions from patients at this clinic were down by a staggering 29 per cent, while hospital admissions were down 6 per cent.
We found happier and more fulfilled doctors, and an evaluation of the model compared with other clinics also showed improved patient satisfaction and cost savings. Despite more doctors and other staff being employed, there was a return on investment of $1.5 for every $1 spent. While there are some forward-thinking UK GP practices doing much of this, it needs to be far more widely adopted.
‘If the NHS is to remain sustainable, there has to be a fundamental shift towards preventing ill health’
There is a realisation that, if the NHS is to remain sustainable, there has to be a fundamental shift towards preventing ill health.
At Kaiser Permanente in the US, a relentless focus on encouraging people to give up smoking has led to a smoking rate of just 9 per cent, compared with over 20 per cent in the UK. They use IT very effectively to target at-risk groups with the aim of improving their health, and have negotiated an agreement with their workforce unions to achieve improvements in employee health.
In England, the Department of Health has recently embarked on a programme that involves identifying pioneers around the country. These pioneers will be encouraged to really push the boundaries of integrated, joined up care.
The government, along with all the key partner organisations, has signalled that we want the NHS and our care system to embrace the whole concept of integrated care, bringing the fragmented parts of the system together, shaping services around the needs of the patient.
We have some inherent advantages in this country, not least the state’s commissioning of social care services. At the same time, public health (now sitting in local government, with an increased budget) can play a central role in preventing ill health.
I believe we have real opportunity – working with doctors, nurses, social workers and other professionals – to develop a shared vision of better care for patients, a much greater focus on prevention, a more fulfilling and rewarding life for those who work in the NHS and care services and far better use of the resources we have available to us.
Norman Lamb MP is care and support minister at the Department of Health