Communication is key
Researcher
As the dust settles on the Government’s long awaited 10 Year Health Plan for England, focus shifts to how deliverable its ambitions actually are, as we explored in our Re:Act snap analysis on Thursday.
The Plan includes a number of strong steps towards the Government’s much touted three shifts: from hospital to community, from analogue to digital, and from sickness to prevention. But to finally deliver these long sought after shifts, collaborative working between different clinicians and NHS organisations needs to be much easier. The Plan overlooks perhaps the most fundamental component of more specialist care outside hospitals: proper communication infrastructure.
There are ideas here that could go some way to helping. The Single Patient Record, collating a patient’s medical records in one place, would reduce time lost trying to access a patient’s relevant medical history. Similarly, it is a worthwhile goal to improve communication between patients themselves and clinicians, with patients far too often left out of the loop on their own care and treatment. The Plan looks to tackle this issue with a direct messaging feature in the NHS App for patients to contact their clinicians.
While the Plan consistently emphasises utilising technologies to transform the NHS and the importance of integration, it does not discuss how to improve communication between different parts of the health and care system, vital for shifting care into the community and delivering patient-centred, integrated care.
Given online messaging took over the world 25 years ago, you would be forgiven for thinking that easy, quick and secure communication between hospital specialists and primary care must be standard practice. We explored this extensively earlier this year in Hospital as a service, not a building, and were baffled by the fact a clinician-to-clinician communication platform across the NHS does not yet exist.
The NHS is often understood by those who use it as one service, but in reality it is a fragmented web of disconnected organisations. It might be surprising to know that, to contact hospital specialists, GPs either have to call the same switchboard as a member of the public or submit a question via the Advice & Guidance system, often waiting days or even weeks for a response. This is ludicrous, creating significant inefficiencies and risking worse patient outcomes, especially for complex and long-term condition patients.
While the Government’s commitment to shifting care into the community is welcome, particularly through the creation of Neighbourhood Health Centres, this shift will only exacerbate the problems and missed opportunities of an inability to easily communicate across the NHS.
Let’s say there is a patient with complex diabetes, whose treatment regimen is failing to keep their diabetes stable or who has other comorbid conditions, like a heart problem. If they are to continue being treated in primary care – rather than referred to secondary care for long-term condition management, as they would be now – specialist support will be needed in primary care.
The primary care clinician, whether a GP, Advanced Nurse Practitioner or clinical member of a Neighbourhood Health Centre, does not have the specialist knowledge to care for these more complex patients. Shifting care out of hospitals is only safely possible if primary care clinicians can easily and reliably ask questions to an appropriate specialist, if they need the expertise or input.
Done right, not only would this be more convenient for patients, providing continuity of care in a setting close to home, it would reduce pressure on hospitals and be more cost effective for the system. This would be a win-win-win, facilitated by appropriate communication infrastructure across the NHS.
So while many focussed on the stones the 10 Year Plan left unturned – from details on delivery, to fixing the basics, to social care – another important, and overlooked, gap is how to improve communication between different parts of the health and care system. Conventional wisdom dictates that communication is key, and this rings just as true for the NHS.