Digital and transformation leads: What is the progress so far?

In October last year the new role of Digital and Transformation Lead (DTL) was added to the ARRS funded roles. The role has a quite wide definition of what its purpose is. Many, including me, welcomed this role as it appears to recognise that implementing digital transformation is perhaps one of the keys to general practices’ evolution and survival and that perhaps there hasn’t been enough head space in primary care management to deliver this at the scale and pace needed.

So now we are approaching a year – how is it going?

As a keen advocate of IT innovation, I’ve just launched a DTL forum to promote the role and help those in the role and we recently had over 100 DTLs come together to discuss it. We meet online every two months though we have plans for a face to face get together in November. I’ve also spoken to a lot of DTLs and PCN managers about the role and how it’s going.

As a clinical director of Sandbach, Middlewich, Alsager, Scholar Green and Haslington (SMASH) PCN in Cheshire I have appointed a DTL and encouraged local PCNs to do the same, alas not all have. Some because they were spent up or had other plans for the ARRS money. Others don’t quite get the role or perhaps think that they should not fund it – after all what do the commissioning support units, integrated care board and place IT people do?

The person I appointed was working as an ARRS pharmacist in my PCN already. She has great IT skills, is studying in her own time for a Masters degree in Data Informatics and is really keen on both developing and implementing new solutions. She does the role half time remaining a pharmacist the other half. Although there are no fixed needed qualifications, she fit perfectly for me.

In quite a few PCNs it appears that the PCN manager has taken the role. This seems to be about securing the funding for the manager role for the long term, as in theory the ARRS money continues and PCN management pots may be eroded.

Also, some smaller PCNs don’t have the budget to cover both clinical director and PCN manager costs. But there is an issue here as the DTL role and the PCN management role are different.

Although the same person could do both roles, there is a danger that the digital role may lose out to the busy day job of running a practice, perhaps two people are better than one, but this is for local decision making based on local circumstances.

There is also the question around is the role purely about digital or just transformation? Clearly the two are linked and there is an overlap, but in my work with DLTs people often come from one background or another and PCNs need to be clear on where they have expertise and where they may be lacking, as both aspects of the role are important.

Digital transformation is about helping deliver all the current hot topics involving IT. Things like cloud-based telephony, digital front door, websites and social media, implementing new IT systems, workflows, understanding Business Intelligence, data quality and coding and so much more. I would expect DTL’s to have a working knowledge of IT and primary care systems or at least have a background that could pick them up rapidly. Some managers from a pure transformation point of view may have great skills at getting people in a room and running stakeholder events and the like but may struggle without a solid IT background.

The experience levels of those in the DLT varies widely. Of the 100 DLTs I met most had experience of NHS primary care but some were completely new. Some were senior strategic thinkers, and some were lower grade and perhaps more focused on technical things from a support background.

There was a range of answers on how engaged their PCN CDs were with them, perhaps reflecting that some practices/PCNs still don’t ‘get’ or agree with the PCN concept or perhaps it’s that some CDs are struggling to find time/funding to do all that is asked of them. It does seem a shame that some DLTs report hardly meeting their CDs.

Quite a lot weren’t sure what they were meant to be doing or at least what their priorities were. The role is conflicted. On one hand its upwards looking reacting to edicts from above – such as implement a new phone system – on the other its about looking after the practices interests and priorities and its clear that there is a variety based on local need/setup and background/experience of the person and the direction of the PCN.

There are also difficulties around the fact that some PCNs are now super practices, some are getting on, some aren’t and that some contracts or edicts are aimed at PCNs and some are still practice based and knowing what to get involved in and help with and who’s responsibility it is to deliver is hard.

At our meeting we identified eight main priorities for people in the role:

1. Implement cloud telephony.
2. Improve access – inc. OC VC triage etc.
3. Help with General Practice Appointment Data (GPAD) reporting.
4. Help with population health initiatives and understanding a PCNs data
5. Help implement new website guidance and work with practices on social media/marketing
6. Improving the training/upskilling of all staff and ensuring ARRS staff feel part of the team and that their work is coordinated with practice staff
7. Find digital solutions to improve back-office efficiency effectiveness and profitability
8. Help deliver hub (cross practice) working for enhanced access (EA) and other activities.

Everyone agreed and we encouraged them to list these in priority order for their PCN, to reflect on who was leading and delivering them and how far along they were. There was clearly a variety in responses with some further ahead than others but there was an eagerness to understand what needed to be done, and to deliver it. There were a lot of good ideas and a range of skills and opinions. I left the meeting quite optimistic.

At almost a year – we have a range of people in post – with skills/knowledge/experiences to suit the local needs, some idea of what needs to be done and a desire to deliver it.

DTLs are looking to improve communications, to learn new skills and knowledge both individually and collectively and I think we have a useful group of people trying to improve primary care – though with big tasks ahead of them. Let’s revisit in a year and see what they’ve done!

If you are in a DTL role and would like to join, connect with Dr Neil Paul on LinkedIn.