Sylvia Davidson

The coronavirus pandemic has accelerated the use of digital health solutions in the NHS. On 5 March, NHS England sent all GP practices a letter advising that patients be assessed  online or via telephone and video appointments to mitigate the potential spread of coronavirus.

Although aimed at around 7,000 GP surgeries, hospital departments also needed to very rapidly reduce face-to-face appointments and change the way they worked.

What happened next has been the most dramatic change in the way the NHS works since its inception. Now almost two months later, thousands of GP surgeries and hospital departments are using video or telephone appointments and millions of patients contact healthcare providers remotely. Digital health solutions are now embedded in the way the NHS works.

NHS Digital reported that in March, the use of the NHS App increased 111%, with repeat prescriptions made via the app up 97% and the number of patient record views up 62%.

Prior to the coronavirus outbreak the service recorded an average of 10,000 users per day, but in March more than 16 million people used the service. Pharmacies also saw an increase in electronic prescription services up by more than 1.25 million in March.

Livi, which already has a foothold in the market as a provider of remote consultations to the NHS through its app, recorded a 107% increase in consultations from 1 February to 13 March compared with the six weeks before.

The change has been a boon to several companies. These companies, already spurred on to develop digital solutions by Matt Hancock’s spaniel-like enthusiasm for apps and the long-term plan published in January 2019, are now becoming embedded within the NHS, probably a couple of years before any of them ever expected to be.

On the 19 March, NHS England issued a 48-hour tender for the immediate provision of online primary care consultation. The accelerated tender documents were issued to a group of 33 trusted NHS suppliers by NHS England National Commercial Procurement Hub. Successful companies were told on 25 March.

There were five lots available, including text messaging, video consultations and automated triage. Eleven suppliers have been selected to provide video consultations for primary care.

Each supplier has been told they will be working with a number Clinical Commissioning Groups (CCGs) but the exact regions are yet to be confirmed. The companies are: LIVI; Doctorlink; eConsult; EMIS; Engage Consult; iPLATO; Q Doctor; Lincus; Ask NHS; FootFall; and Visiba Care.

Some of the technology to be supplied is Covid-19 specific, including Engage Health Systems and eConsult’’s technology to provide a template which will signpost patients with suspected Covid-19 to appropriate services after they’ve answered a series of yes/no questions. Other technology is applicable across the NHS, such as video consultations and text messaging technology.

Digital Health News reported that it’s not known whether the big names like Babylon bid on the tender, but the company is absent from the supplier list.

Outside of the NHS England tender, providers of digital solutions to GPs had already responded to produce new products and many were already reporting an increase in uptake.

After the letter from NHS England, many GPs turned to the company accuRx. The company’s technology was already being used by many doctors for sending text messages to patients, but accuRx rapidly built a video-calling system and it now provides the video system and a screening survey for free to GP surgeries.

Nye Health, a company specialising in primary health, reported that it has had rapid uptake of its new platform that allows all GPs in the NHS to carry out appointments remotely, designed specifically to respond to the current pandemic. The company already works with many GP surgeries in Oxford, but is now seeing enquiries coming thick and fast from other areas.

Babylon Health, perhaps the best known of the digital health companies, has devised its own Covid-19 app, the COVID-19 Care Assistant, and made it available to its NHS  and private patients. On 8 April the Royal Wolverhampton NHS Trust (RWT) and University Hospitals Birmingham NHS Trust (UHB) began using the new service to support and monitor coronavirus patients 24/7 in the community. All together Babylon Health notes that the app is now available to 4.2 million patients.

Back in early 2020, the Royal Wolverhampton Trust signed a 10-year deal with Babylon to develop a “digital-first integrated care” model.

Other companies have accelerated the launch of products. DrDoctor has launched a free Covid-19 toolkit for NHS trusts, which includes the company’s broadcast messaging and video consultation services along with a digital symptom assessment tracker. The toolkit was originally due for launch at the end of 2020.

The tools enable consultants to carry out remote consultation capabilities in hospitals and communicate any service changes to patients. DrDoctor’s Symptom Tracker can send digital assessments to patients to screen for coronavirus symptoms before hospital appointments or on an ad-hoc basis.

In the Midlands, Walsall Healthcare NHS Trust has implemented online consultation software from Healthcare Communications. The E-clinic software allows patients to see their clinicians via online consultations, from their own homes, meaning that regular health checks and medical reporting can continue even if patients or healthcare professionals are self-isolating. The trust has 40 clinicians set up to use the system.

A major component of the long-term plan published in January 2019, was the digitisation of the NHS. But nobody could have foreseen how quickly this would take place.

How successful it has been is an unanswered question, however. The figures show that people are using the systems, but there is no way of knowing yet how many people are being left behind and unheard due to a lack of tech knowledge or the hardware to access digital health. There is also no way of knowing how many people will stick with the remote consultations when they are not obligatory.

What is certainly true is that after the pandemic, the NHS will not go back to the way it was working. Things have changed, the NHS is now a long way down the road to digitisation. In some respects this is a positive for the NHS, it has exhibited the ability to rapidly change and innovate, something that many critics wouldn’t have thought possible even a few months ago. In the area of IT, the NHS has a history of disasters and was a laughing stock for its continued use of fax machines.

The spread of the technology among NHS primary care and hospital trusts has also put the NHS in an excellent position to compete with digital health companies, such as Babylon Health. The latter has sought to compete with the NHS’ system of primary care more than any other digital health company. Its model is one of remote working, using its own GPs, with a limited physical infrastructure. Patients who signed up to Babylon, although still treated by the NHS, had to leave their GP surgeries and re-register with Babylon.

Now, however GP surgeries and hospital departments will be able to offer a range of appointment solutions, all without having to register with a different GP. They can offer all the advantages that companies like Babylon boast of, but without the downside of not having a local physical surgery for attending when you really need to.

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