It’s time to measure performance on patients’ priorities

The Prime Minister says he wants to prioritise the NHS, so let’s start by prioritising – and measuring – what matters to patients.

With such a strong focus on Brexit, it’s easy to miss that the Conservative’s key domestic pledges at the last election had a notably different emphasis compared to past campaigns. “£33.9 billion extra for our NHS, 20,000 more police officers and more funding for school pupils” may cover off traditional electoral topics, but their focus on inputs rather than outputs is an unusual departure for the Tories.

The key to keeping those newly won seats in areas as diverse as Blyth Valley, Dudley and Kensington will be to translate those inputs into meaningful change in public services. Achieving tangible change is much harder than making headline funding commitments. The frustrated and increasingly cynical electorate public needs to feel those changes in everyday life.

The Government’s commitment to tackling this is clear. The Queen’s Speech contained four new health Bills including a legal commitment to funding. Though beneath the headlines, the draft bill on making the NHS long-term plan real will likely have the most impact in how it shapes the future direction.

Crucially though, there is a set of decisions that do not require legislation but will determine priorities: the things we measure.

If the NHS is serious about tackling things that patients really notice, like how long it takes to get a GP appointment, or even whether it is possible to get through to the GP practice in the first place, then this information needs to be systematically collected.

We already have the means to collect some of this data, e.g. through the NHS app, and that sort of information is routinely collected by digital health providers – along with a host of other arguable metrics. However, for most people who typically call their GP service for an appointment, we only have a partial picture available. That’s a big gap, and frankly, it sends the wrong message.

So, a good start when thinking about how to make the changes feel real, is measure what matters to patients. Let’s start by getting a full picture of how easily we can get appointments to see GPs.


A digital (state of care) mind

Last week, the Care Quality Commission published its annual state of care report. Among the usual rhetoric of “the NHS is improving but there’s still a lot we need to get right,” it was interesting to see how much they have focussed on digital care and how much CQC can be used as a lever to ensuring that everyone who wants to, can benefit from the full range of digital services, regardless of their personal circumstances or where they live.

At the DHC we’ve been working closely with the CQC to help move this agenda forward. We were delighted that Push Doctor were awarded four “goods” and an “outstanding” in their most recent report and that other members of the Digital Healthcare Council (DHC), such as Babylon, have had equally favourable inspection results. Indeed, the apocryphal story of the CQC inspector reviewing a digital only service and asking to see the washbasins, is being told less and less.

In this year’s report, the CQC note that “The most significant change that we have seen through our regulatory work is the provision of online appointments alongside telephone appointments”. They quote figures from May 2019 that 0.5% of appointments with an NHS GP were delivered online. We expect this to rise exponentially in the next reporting period. We estimate that about 10 million people have access to online general practitioners, through their existing GP surgery or by joining a “digital first” practice. Some of our DHC members Babylon, Care UK, Doctorlink, Livi and Push Doctor have been leading the charge. Through their membership of the DHC they’ve been able to collectively feedback to NHS England’s Digital First Primary Care Policy Consultation to harness the potential of digital providers. Helping reform patient registration, funding and contracting rules to ensure patients have both choice as well as access to integrated care. We also welcome the regulatory sandboxing work CQC are undertaking, encouraging collaboration between providers, innovators and CQC. This looks to make the inspection process more equitable and help it evolve to properly reflect the needs of providers and people who use services.

However, online primary care is still perhaps no more than an appendix in the state of care report. As appointments are only at 0.5% one can perhaps understand why, but conversely maybe CQC haven’t quite linked how digital care can be a solution to some of the NHS’s more challenging issues that the report has once again highlighted. For example, one of the report’s leading facts is that one in eight people went to A&E instead of taking the GP appointment offered. This should come as no surprise to anyone in the industry: patients are struggling to access non-urgent care, which ultimately puts pressure onto urgent care services.

The DHC passionately believes that digital care, working hand-in-hand with face-to-face provision, is an increasingly important part of solving access to care. Primary Care Networks (PCNs) are being triumphed by NHS England as the solution to these access problems. The main benefit to people of the PCNs is the choice that is offered to the public, who on average see their GP six times a year. Within the PCN arrangement, appointment one, might be a video consultation for a trivial matter that can be dealt with in quiet space at work, appointment two, for something much more serious might be face to face in the practice, with “your GP” whom you’ve met before and trust for a more personal discussion, appointment three might be face to face for something that can’t be dealt with over video but on a weekend at another practice within the PCN that offers extended hours… and so on. Thus, digital partners will play a key role – alongside and not replacing face to face options – in reducing some of these access variations.

What is absolutely welcome in the state of care report, is the section on using technology to reduce inequality and promote people’s rights. One of the priorities for the DHC in 19/20 will be examining the need to mitigate the risk with benefits of tech – there is a danger of excluding communities of people e.g. foreign language speakers, disabled people and those unable to afford technology. The DHC look forward to working closely in the future with CQC so all who want to can access safe digital services at scale.

If you are interested in finding more about the work we are doing at the DHC and becoming a member, please contact