Andy Cowper explains why the DHSC’s latest push to overhaul IT in primary care does not make sense

As far as one can tell, cosplaying Secretary Of State For The Time Being Matt ’Appless ’Ancock’s personal motto seems to be “if at first you don’t succeed in making the entire NHS think you’re hoping for a post-office GP At Hand job, try, try again”.

The latest PR push by the Department For Health But Social Care is a bathos drenched piety fest that claims “We are overhauling outdated IT in GP practices. We are creating an open, competitive market so the best tech companies invest in primary care. New systems will work across the entire NHS”.

Oh dear. Primary care IT is not even in the top 10 of really big problems facing the NHS. When you read the DHSC press release (of course there’s no actual framework document: don’t be so analogue, baby!), you will be heartened to find that “by 2023 to 2024 we want every patient in England to be able to access GP services digitally, with practices able to offer online or video consultations”.

So far, so Babylon.

Never mind that EMIS already offers the opportunity to do video consultations. That is just a fact, and you can’t go around cluttering up a press release with inconvenient things like facts. A press release needs to say things like “the current market is dominated by two main providers, which slows down innovation and traps GP practices in long-term contracts with systems that are not suited to the digital age”.

Well. If EMIS want to adapt to the digital age, they probably just need to find a chief executive with a talent for publicity.

The DHSC press release also vows that “the changes will free up staff time and reduce delays by allowing seamless, digitised flows of information between GP practices, hospitals and social care settings”.


The Inverse Scare Law

Mr ’Ancock is a frightened man, and with good reason. He has seen the briefings on what a “no deal Brexit” would bring, and the TL;DR summary for the time poor is “chaos and avoidable fatalities”.

I have been trying to avoid leaping to premature judgement on Mr ’Ancock’s aptitude as health secretary. He has not been making this task easy for me.

So, here goes. This initiative is cobblers for the following reasons.

Fighting the wrong battles in the wrong places

The first is that Mr ’Ancock is trying to solve a problem that is, in the scheme of big problems facing the NHS, not particularly much of one. This IT obsession comes across as if it is a proxy war; an attempt to distract from the big, real problem facing almost all parts of the NHS: that of workforce shortages.

A “big push on IT”

Primary care has long been at the forefront of IT adoption in the NHS because as (mostly) a collection of private businesses, there was a clear return on investment for GMS partners to go digital.

More to the point, the deals done back in the day by the DHSC over the digitisation of primary care made the adoption of digital technology in effect free for all but the very earliest adopters.

The second is that Mr ’Ancock’s new IT initiative suggests that he and/or the DHSC know how to make a market that will speed up innovation, not tie GP practices into long term contracts and not end up with a smallish number of dominant players (<*coughs*>‘GP At Hand job when you’re not SOS any more’ </*coughs *>.)

To put it mildly, we have zero evidence that this is likely to be true, and considerable evidence that Mr ’Ancock is in inexplicable and repeated thrall to one particular player in the market. Which is wholly inappropriate, and, as I previously noted, sits ill with the ministerial code.

Third, there is the question of the proposed perfection of patient record interoperability. Mr ’Ancock has perhaps not yet realised that not all acute providers, social care providers and indeed ambulance trusts use the same software. Indeed, in some organisations, there is not always full information interoperability within the organisation.

As such, the eye catching PR pledge that “new systems will work across the entire NHS” looks like nonsense.

It’s the workforce, stupid

The really big problem facing primary care (and indeed the broader NHS) is not IT. The really big problem is workforce, and specifically workforce shortages.

Yes, it would be very nice to be able to miraculously modernise and render fully interoperable all NHS IT. That would make real improvements to staff quality of working life, and give some useful gains in both working time and patient safety.

There just isn’t the money to buy the required hardware, software, infrastructure upgrades and fund the training.

What would make a meaningful difference would be an interoperability charter, led by clinical experts and healthcare IT specialists as well as potential suppliers. It could work with established networks such as the academic health science networks. It should take a 10 year timescale, and have some seedcorn funding to research and spread the best workarounds with legacy technology, recognising the reality that it’s going to be around for some time yet.

That doesn’t sound much like a snappy press release, does it? But it does sound like something that might actually work, and make a sustainable and real difference.

As for workforce? Obviously, Brexit is screwing up an already bad situation. If the atmosphere of hostility towards immigrants continues, the ability to mitigate our longstanding failures in training and retention of staff by importing from overseas will be ever harder.

The Inverse Care Law

Meanwhile, research commissioned by the Financial Times from the Nuffield Trust has shown – surprise, surprise – that the Inverse Care Law is alive and well in primary care.

In the words of its codifier, the late Julian Tudor Hart, “the availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced. The market distribution of medical care is a primitive and historically outdated social form, and any return to it would further exaggerate the maldistribution of medical resources”.

That is another big, real problem facing the sector: we can look forward to the DHSC press release on that one with eager anticipation. We could all do with a good laugh.

Happy New Year to you all, and best wishes for a healthy 2019.