NHS England has launched a video featuring ‘Egbot’, their vision for the future of the health service.
The video features Egbot waiting three seconds before the surgery answers its call, then standing in a ‘crowded’ waiting room of five patients ‘usually during working hours’.
Apparently what’s worse is Egbot turns up and is seen fifth (in other words, in order of appointment). This is portrayed as a disgraceful outdated system, which harms patient care. Egbot is then given a prescription but not told where the nearest pharmacy is.
Personally, I’m really excited about using information technology to improve patient care. In our surgery we use electronic prescribing, allow online booking of appointments and ordering of repeat prescriptions and I regularly build ‘protocols’ to make safer systems: prescribe amlodipine and simvastatin together? You’ll get a huge pop-up alert. Enter a blood pressure? It’ll be interpreted for you.
But I am deeply offended by this advert. The animated film reveals the rotten core of the Department of Health’s vision for general practice: that patients want consumerist transaction-based healthcare, with access being vital and continuity of care unimportant.
This is highlighted further by the ‘utopian’ system being based on a conveyer belt. Why do you need an app to tell you where the nearest pharmacist is when our helpful receptionist can do that quicker? And can you remember the last patient you saw who didn’t already know where the local pharmacist was?
Yes, patients want better access and NHS Choices, 111 and other systems can play a part in this. Patients still value continuity of care – mine repeatedly tell me they want to see ‘their’ GP.
But patients also want longer opening hours. The vision portrayed on the video is where competition rules, and patients are enabled and encouraged to move to practices which offer 24/7 opening hours and are IT-enabled. The logical outcome of this is that any practices not willing to open 24/7 will have to close as all their patients migrate to more ‘patient-friendly’ practices. What grates here is that this is entirely an urban-centric picture of general practice. Most patients in rural areas don’t have a choice of practice.
How much of the Department of Health’s time, effort and budget is being spent pushing this IT enablement and choice agenda that will disproportionately benefit healthy, middle class, urban populations when they could spend that time, effort and money to address the drop in medical school applications, the drop in GP training applications, the unfilled training posts and the unfilled GP posts across the country?
Of course the Government should pursue using technology to improve health and reduce health inequalities. However, its number one priority should be to explain to the public the reality of general practice, and to stop inflating their expectations.
It should spend our taxes to ensure a fully-staffed, high quality 8am-6.30pm GP service across the country, supported by quality out of hours services, and with buildings fit for purpose.
I’m sorry to inform Jeremy Hunt that being able to send my blood sugars to my GP via an app is just not as important.
Dr Phil Williams is a First5 GP in Lincoln, and former RCGP National Lead for the First5 initiative