The NHS Long Term Plan: Digital-First Primary Care

Published 28 enero 2019

The NHS may not be the quickest to adopt new technology (Secretary of State Matt Hancock recently banned NHS organisations from buying new fax machines), but the NHS Long Term Plan demonstrates a clear strategy to embrace new technology, with an entire chapter solely dedicated to digital technology with clear milestones in the coming years. Primary care digital-first appointments through video consultations have been under the spotlight recently, and feature in the Plan, with every patient in England to have the right to choose digital consultations from their own practice or a digital GP provider.

The aims for digital technology reflect the overall objectives of the Plan – patients to be cared for within their homes and to have greater control over how their health and care is managed. By supporting a cohort of patients digitally, the idea is that clinicians' time will be freed up for those that do not want to access digital consultations, or have complex needs requiring face-to-face care. The Plan suggests that offering a digital first option to some patients will provide “longer and richer face-to-face consultations with clinicians where patients want it or need it”.

What does the Plan promise?

As well as digital GP consultations for everyone that wants one, the Plan promises:

• Further development of the NHS App to provide advice, check symptoms and connect people with healthcare professionals through video and telephone consultations;
• Continued investment in the nhs.uk platform;
• Further development of innovative devices such as smart inhalers, remote monitoring of conditions, as well as wearable and home-based devices to monitor health; and
• More apps and online resources to support good mental health and enable recovery.

The Plan is not simply a list of promises, but there are clear commitments with target dates:

What are the next steps?

There is significant capital outlay and work to do before primary care is fully digitized but the Plan acknowledges this, with practical next steps. This includes:

(1) Creating a new framework for digital suppliers to offer their platforms to primary care networks on standard NHS terms. This will be welcome news to digital health services providers as it creates a more structured route to market. However, some thought will need to go into drafting these standard terms to ensure that non-NHS provider companies are not disincentivised. There will be challenges to both commissioners and providers who want to negotiate on key terms, such as the use and ownership of intellectual property, and the standard terms will need to allow some flexibility with this.

(2) Reviewing the current GP payment formula to ensure fair funding without favouring one type of GP provider over another. The Carr-Hill formula, which determines how much funding practices receive and is linked to list-size is likely to change. NHS England has previously proposed that payments per patient are reduced by almost 20% for digital providers as they are less likely to attract patients with complex needs.

(3) Reviewing GP terms and conditions to better support GPs wanting to work this way. The Plan stresses the importance of supporting return to practice and increased participation rates by GPs. This will hopefully help the much-publicised decline in GP recruitment and retention.  

Our view

The Plan describes an exciting vision for the future of primary care and is welcomed by both patients and NHS front-line staff.

The big questions are whether there will be the money to upgrade the primary care infrastructure to allow for this to be realised; whether different types of providers will be appropriately incentivised and supported to work in this way; and whether there is sufficient time to properly upskill clinical staff.

Digital technology will also need to be developed against a complex legal framework including: information security, confidentiality, intellectual property and regulation of digital solutions as medical devices. It will be up to those first movers in this market to work collaboratively with the regulators in order that they can understand the key issues to ensure a safe service. Once the regulatory framework for these sorts of digital first solutions evolves, there is likely to be more investor interest and consolidation of digital first providers, particularly given the proposed framework approach.

Should you wish to discuss any of the issues set out in this article, please contact: