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GPs urge ministers to rethink telehealth drive as low takeup in pilot area revealed

By alisdair stirling | 19 Jan 2012

One of the country's biggest telehealth projects is so underutilised that PCT managers have been forced to offer GPs cash incentives to refer to the scheme.

GP leaders warned that low engagement among practices could prove a major stumbling block to the Government's telehealth drive, as ministers launched a campaign claiming the initiative could transform the lives of three million patients.

NHS North Yorkshire and York bought 2,000 telehealth units from manufacturers Tunstall in early 2010, following a successful pilot scheme in 2009. A total of 1,500 units were projected to be in use by last April.

But PCT board minutes reveal that by last June only 350 of the 2,000 units had been used, with minimal takeup among GPs. Just seven practices had referred patients for 34 telehealth units, with the remainder used by community and secondary care.

A PCT spokesperson told Pulse that the number of units in use had risen to 659 by December, but  admitted the trust faced ‘challenges with getting some GPs engaged', and said it was now offering cash incentives for practices to take part.

GPs will receive a one-off payment of £200 for signing up to the telehealth deployment, plus £50 per patient for installation, with a further £50 per patient for those requiring telehealth for six months or longer.

But Dr John Crompton, chair of North Yorkshire LMC, said: ‘We´ve always had concerns that there wasn´t enough evidence base for the purchase of such a large number of units.'

‘There are questions over whether this is the most appropriate use of scarce funds.

The low takeup in the largest telehealth scheme outside the Whole Systems Demonstrator programme, the main national pilot, comes as ministers pledged to bring telecare to three million patients within five years (see box).

But Dr Paul Cundy, chair of the GPC´s IT subcommittee, predicted that poor take-up by practices could force the Department of Health to ‘rethink the whole thing'.

‘Your average GP needs substantial convincing that there is any benefit to telehealth and this is a very good argument for putting GPs in charge of commissioning,' he said.

Writing in the BMJ this week Dr Margaret McCartney, a GP in Glasgow, questioned the evidence-base of the project, and pressed the Government to publish full trial data from the whole systems demonstrator programme.

‘Without evidence this becomes a public relations stunt, not a cost effective practice,' she said.

 

The ‘three million lives' campaign

Health minister Paul Burstow this week announced a concordat between the Government and the telecare industry and announced a national telehealth drive to transform the lives of three million patients with long-term conditions within five years.

The rollout follows results from the two-year Whole System Demonstrator programme, which studied the impact of telehealth on 6,191 patients across 238 practices and found a 45% reduction in mortality and a 20% fall in emergency admissions.

However the DH has yet to publish the full trial data behind the headline findings.

READERS' COMMENTS

Jamie Cole, Work for health provider,
19 Jan 2012
This is very interesting! Maybe it was because there wasn't the right implementation plan in place from the start? I'm amazed that they would spend £2 million on 1500 units before they have even identified the 1500 patients!!!

I bet they are sat on a shelf somewhere now costing more and more money.

Make practice managers 'telehealth champions', include commmunity nurses, INVOLVE CARERS AND RELATIVES, and ensure that you have the market selected before you go and spend that kind of money.

Surgeries can easily draw down a list of everyone who has COPD in their surgery; contact all these peoples carers and ask them for their participation. That way there is not such a reliance on the GPs to manage this.

I know everything I have said is 'easier said than done' but if I counter that with another saying of 'If there is a will, there is a way' then you can certainly find 1500 people who could benefit from this.

Make the supplier take more responsibility too - in my business I understand that its a big task to identify potential users so I offer to literally come sit with the social workers and file through potential customers to show them how it could help. And I do this because it's not up to the the social workers to do the selling/application - they need help to do this.

Would love to chat further about this!
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Bryan Moore, Private GP,
19 Jan 2012
One has to look at who drove/ is driving this process. There is this mistaken belief that this is the "way of the future" and what patients and providers want. It isn't. Nobody bothered to ask.

At our practise we surveyed our patients in regard to electronic consultation and "telehealth" and - although the final analysis has yet to be completed and written up (other events interceded) - the overwhelming response is that patients prefer the face-to-face consultation.

A computer screen does not provide the "warm glow" of personal interaction, the reassurance of a caring word or "laying on of hands" (for want of a better phrase).

General Practice IS about the provider-patient relationship and ISN'T about the simple pursuit of numbers. Those who fail to understand this implement programmes that are thus doomed to start with.

Anybody heard of "market research"? Did anybody do any? Doesn't look like they did. In the real world this is what you do before investing millions.
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Anonymous, Other healthcare professional,
20 Jan 2012
I wonder if the "telehealth units" are actually doing anything that the patients think are useful?

Have a LTC? Here, let's make the management just a bit more complicated by giving you a box that goes bleep!

Remember that with a LTC the expert is not sitting in the doctor's chair - it is the person sitting opposite the doctor: they have to live with the condition 24x7 and have learned how to cope. I wonder if these units have been designed starting at the patient and how they manage the condition, or starting with the condition from the clinician's perspective?
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Simon Gilbert, Salaried GP,
20 Jan 2012
It would be useful to see the cost effectiveness data from the Whole System Demonstrator so that telehealth can be compared to other interventions e.g. increased nursing support for patients with long term conditions.
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Anonymous, GP Partner,
20 Jan 2012
My experience with some patients on telemonitoring is that it may actually be causing them more harm in increasing anxiety levels as they get so wound up as to what their bp/pulse/sats etc are.
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Surjit Bhandal, Other healthcare professional,
20 Jan 2012
There are some judgemental comments here, made - without knowing the real facts. Telecare/telehealth can only be driven by need and by evidencing the benefits. It is not suitable for all, just as any other solution may not be. Sometimes a medication works for a diagnosis for one patient and sometimes it doesn't but you don't write it off for all patients. Telecare/telehealth is no different.
The problem is that when it is provider driven - it won't work. It works when the client, the provider,and the commissioner work together.
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Anonymous, Other healthcare professional,
21 Jan 2012
Many Carers of disabled people expressed concerns years ago when these schemes were first consulted upon. What they said was they were no good were the vast majority of patients were elderly and suffered from dementia. Mostly they concluded that these systems constitute a "spy in the bedroom" and were afraid that the data could find its way to other government departments and could possibly be used against them for things like social security benefits. If the government would honour its commitment to the "Carers Strategy", most of the functions supposedly provided by telehealth units would easily be achieved at far less cost and with less anxiety for patients and their Carers.
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Bryan Moore, Private GP,
22 Jan 2012
Sorry to burst your bubble but this is not what the evidence - such as it exists - supports. In programmes where "telehealth" works it is because it uses easily measurable parameters. For example a patient in a remote location who has multiple chronic conditions (say Diabetes, hypertension, heart failure) who can report pulse, BP (excluding the debate about the accuracy of NIBP monitors in elderly patients), O2 sats, blood sugars via a networked monitoring system (i.e. you can view the log) and who can then receive information on Insulin dose (if appropriate), diuretic therapy adjustment etc. It does NOT work when used as a diagnostic tool or addressing complex interactions from medications etc.
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Anonymous, Other healthcare professional,
09 Mar 2012
Hmmm.....

Throw money at GPs to do something. That'll work.

Many people are viewing thks as a proof of concept. By their nature these projects will throw up problems but they need to be tried on a scale large enough to capture quanitifable information. Small scale trials are a waste of time as the data is skewed by unexpected phenomena.

Also I see that one of the failings is that the ROI gets worse the longer the patient lives. What happened to trying to save lives?
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