Yesterday we were privileged to be joined by staff from the Grantham Practice, a local GP practice based down the road from Health Foundry in Stockwell. The staff shared their current challenges of running a busy inner city GP practice with Health Foundry members. Members also had a chance to pitch their innovations to the practice and get feedback on what they are working on.
The lunch kicked off with Dr Vikesh Sharma who shared some context about the surgery and their patients. The Grantham Practice is based in Stockwell - an area of London with a contrasting and diverse population. On one hand, it’s in one of the most deprived areas in London, but it's also home to a growing middle class with a wealthier population as the area regenerates. The practice has a list of 8,000 patients of which around 1,000 are over 65. The patients come from 66 different nationalities, which can cause language barriers. The practice receives just over £100 per patient per year from Lambeth CCG and has five doctors and eight administrative staff.
Dr Vikesh then summarised the challenges that his practice faces, both on a macro and micro level. The first challenge is one that is common in primary care - the increasing complexity of their patients’ conditions with co-morbidities. This creates complications with medications and fragmentation of services for the patient. The practice is also seeing an increase in the number of frail and elderly people and a major challenge is trying to prevent this cohort of people going into crisis and deteriorating.
The rise of obesity, and especially childhood obesity in the local area, is of growing concern to the practice. They are seeing an increase in people presenting with cardiovascular disease and Type 2 diabetes and battle with how to encourage these patients to self-care better. The practice is also seeing more people coming in with mental health problems, something that Dr Vikesh said that primary care is not well equipped to deal with.
Lastly, the practice has a personal interest in health inequalities. A patient in their practice can have a 10-year life expectancy difference depending on where in the locality they live. A further challenge the practice face, like all GPs, is the tensions between the government pushing for increased access to GP services while the commissioning framework is not set up to reflect what Dr Vikesh called “the vagrancies of demand”.
The team also outlined their technological challenges. The patient record system that they (and all of Lambeth GP practices use) is EMIS. Unfortunately, EMIS is not very good at integrating with other platforms making it very difficult for the GPs to use external apps and platforms. The practice does have wifi but again this comes from the CCG so it is not configurable, for example, they can’t change the first screen that patients see. The team explained that the CCG hold the budget for devices, platforms and licences so they have little control over what they can use.
Our Health Foundry members then had the opportunity to share their innovations and also ask questions of the team. It was obvious that the practice is quite forward-thinking in terms of digital innovation and are even advising some health tech startups. However, some key barriers and takeaways emerged:
Firstly, was the barrier of adopting new technology. Busy GPs and staff don’t have time to log into another platform. They want everything to be integrated into EMIS or SystmOne. GPs also don’t have time to learn to use a new platform, especially one with a poor interface. One of the staff said that she had a “toddler test” for new technology - it needs to be easy enough for a toddler to use. Staff will consider if they need to use a platform at all, especially if another process is working OK. Data sharing is also a massive problem. Many people don’t realise that GPs, as they operate as a partnership, not a limited liability company, are personally liable for any data breaches so they are understandably cautious.
Secondly, was the importance of the GP-patient relationship. GPs are conscious that technology has the potential to take something away from this relationship which, importantly, is not just about someone’s medical condition, but them as a whole person with a multitude of needs. For any innovation to be recommended to patients, it needs GP buy-in. There are very few sources of information that GPs will use to recommend to patients. The Grantham Practice use Patient.info and also information (eg info sheets) that they have developed themselves. The practice is also acutely aware of not further increasing health inequalities by recommending digital innovations that perhaps only a segment of their population could access.
Thirdly, was thinking about the digital products themselves. The team shared some fundamental principles that must be in place before they would consider a technology. Is it clinically effective and safe, and where is the evidence (research paper, pilot or trial) to support this? Does the innovation make sense within the consultation environment or does it stop the flow? Lastly, will it improve patient experience and reduce GP appointments.
Thanks to Dr Vikesh and all the team from the Grantham Practice for a super useful session. If you’re interested in taking part in similar activities like this, then do look at our membership options which start at £20+ VAT per month.