Using technology to build a partnership of trust with patients

Professor Sir Chris Ham writing at The King’s Fund: Recently I spent a day visiting the Haughton Thornley Medical Centres in Tameside, Greater Manchester, at the invitation of Amir Hannan, one of the partners in the practice. I’ve been aware of Amir’s work in engaging patients for some time and it was featured in our 2015 report on innovations in care. I jumped at his invitation and was fascinated by what I saw.

Amir showed me how patients access their own health records and gain a better understanding of their health care needs. Access and understanding are enabled by the use of apps that provide full online access to the GP electronic health record alongside the practice-based web portal. Patients are also able to book appointments, order repeat prescriptions and send two-way secure messages online.

Innovation in Care

Two-thirds of the 12,500 people registered with the practice have signed up (after an individual consenting process) for the online service and all the patients I met were aware of the service and were using it. This is a much higher coverage than in the rest of general practice, where the most recent GP patient survey shows awareness of online services offered by GP practices is still relatively low with use of these services considerably lower. The last survey showed only 3.3 per cent of respondents were accessing their medical records online.

Access to records and understanding are the foundations on which Amir, his partners and other colleagues have sought to build a partnership of trust with patients and staff. They are doing so in a practice that was formerly run by Harold Shipman, who achieved notoriety when he was convicted of murdering some of his patients between the 1970s and the 1990s. The commitment to responsible sharing and partnership has helped restore confidence in the care that is provided, and the practice was recently rated outstanding by the Care Quality Commission.

I saw how this works by sitting in on Amir’s morning clinic with his patients. The philosophy I observed was of patients being enabled to take more control of their health and wellbeing, for example, by checking test results, identifying and flagging any errors or omissions, and tracking trends in their care. Later in the day, I tested my observations in a roundtable discussion chaired by Ingrid Brindle who leads the practice’s patient participation group.

One of the benefits for patients is that they can share their records when they come into contact with other services and with family and carers. The latter is valuable for patients who are not confident in using online access themselves. There are particular benefits for patients with long-term conditions who are able to monitor their conditions and use information on their records to adjust their choices.

Reflecting on what I saw and heard, I was reminded of a phrase I heard many years ago on a visit to Kaiser Permanente in California, US. One of its medical leaders, David Sobell, told me that the most important primary care providers are patients themselves; the decisions patients take every day have a bigger impact on their health and care than those made by GPs, nurses and other clinicians. Systems like Kaiser Permanente had been slow to recognise this and Sobell was leading work to promote greater self-care by patients.

The NHS has also been slow to turn the rhetoric of patient engagement and patient empowerment into practice. The experience of Amir Hannan, Ingrid Brindle and their colleagues shows that progress is possible where there is a sustained commitment to develop a partnership of trust with patients. To be sure, the Haughton Thornley Medical Centres have more to do to get all clinicians, patients and the wider health and social care system involved, but their work demonstrates what can be achieved even within the limitations of existing systems and workload pressures.

What I saw was an example of the kind of NHS we need in the future, based on different relationships between patients and clinicians. These relationships have to be seen as meetings of equals in which the expertise of patients is at least as important as the expertise of clinicians and managers. They must acknowledge the responsibilities of patients as well as their rights and the vital contribution of patients in using information and understanding to improve their own health and wellbeing.

Technology can support this transformation, but fundamentally it is about a new deal with the public appropriate for the 21st century. As Derek Wanless warned in 2002, the public must be fully engaged in their care, otherwise the NHS will become unsustainable. The accumulation of many more locally led innovations, such as the one I observed, offers one promising way of heeding his warning and putting patients at the heart of care. I was left puzzled as to why all practices aren’t yet working in this way.

Have you seen blood in your pee, even once?

Then it is time to tell your doctor.

As part of the relaunched NHS/PHE Be Clear on Cancer ‘Blood in pee’ campaign this post tells you about bladder cancer and kidney cancer.

If you have seen blood in your pee even once, then you need to tell your doctor.
It might not be anything serious, but there is a chance that it could be a sign of bladder or kidney cancer.

See your GP

What are bladder cancer and kidney cancer?

Bladder and kidney cancer are serious illnesses.
One of the signs of both types of cancer is blood in your pee.
More men than women get bladder and kidney cancer. You can get these cancers at any age but most people are over 50.

You are more likely to get bladder or kidney cancer if you:

● Smoke
● Are overweight
● Have worked with some chemicals
● Have other illnesses like kidney failure
● Have someone in your family who has had cancer. This could be a brother, sister or parent.

Look before you flush
If you have bladder or kidney cancer, finding out quickly means it is easier to treat and could save your life.
So make sure you look before you flush to see if there is any blood in your pee.

How to spot it
Blood in your pee could be a sign of bladder or kidney cancer.
The blood in your pee might be bright red. It could also be a pink or brown colour.
There could be a lot of blood. Or there could be just a small amount of blood.

You need to see your doctor straight away if you see any unexpected blood in your pee.

You also need to see your doctor if:

● You have had an infection called cystitis that is not clearing up or keeps coming back
● It hurts to pee
● You have a pain in your side below the ribs that does not go  away
● You have a pain in your tummy that does not go away
● You are losing weight for no reason.

Why do you need to see your doctor?
If you have blood in your pee or any of these other signs you need to get it checked out. Your doctor is there to help.
It could be that you have an infection, which also means you need to see your doctor.
If you still have any of these signs after seeing your doctor they will want to know. You will need to see them again.
If you know anyone else who has any of these signs, get them to see their doctor.
You can find your doctor’s contact details at:

www.nhs.uk/findgp

Seeing your doctor early could save your life

A few years ago Geraldine saw blood in her pee. She knew something was wrong so she saw her doctor straight away.
She had some tests and was told she had bladder cancer.
After treatment, she got better and was soon well enough to go sailing with her husband!
She says she is very glad she saw her doctor quickly and her cancer was caught early.

Keeping well
There are things you can do to give you the best chance of not getting cancer.
Stop smoking
The best thing you can do to keep well is to stop smoking. It could also help stop you getting many different types of cancer.
You can get lots of help to stop smoking. Go to the website:
www.nhs.uk/smokefree
Or call:
0300 123 1044

Keep active
Try to stay a healthy weight and keep active. The more you do, the better.
Try:
● swimming
● cycling
● dancing
● dancing
● walking.

Eat well
It is good to try and have a healthy diet.

Cut down on drinking

Try not to drink too much alcohol.

More information

You can find out more about the best ways to try and not get cancer at: www.nhs.uk/reduce-your-risk

How to find out more
If you want to find out more you can go to our website:
www.nhs.uk/bloodinpee

You can also download this post in different formats from the website. Or if you want to order copies of this leaflet email:
enquiries@phe.gov.uk