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.

Nearly half of GP contracts go to private sector

Be Warned – our health service is being destroyed by a creeping and systemic disease that has taken hold.

Up to 40% of NHS contracts, worth £2.3billion, have gone to private firms since David Cameron came to power.

Four out of 10 contracts for GP services, medical centres and nursing homes are being won by the private sector following the shake-up of the National Health Service, according to Labour research released today.

And the amount of private work by NHS trusts has risen by 58% in the same time.

Health ServiceResearch by the NHS Support Federation published today also concludes that the number of private firms delivering NHS care has risen dramatically. It calculated that the private care sector clinched contracts totalling more than £3.5bn in 2014/15, five times the previous year. Its conclusions follow an analysis by Imperial College London, which found that for-profit providers of GP services are outperformed by traditional GP practices.

Labour’s research shows that 40 per cent of contracts placed by the Clinical Commissioning Group (CGC), which are responsible for spending the vast majority of health spending, have been handed to private companies, compared with 41 per cent that were won by the NHS. The remainder went to charities, social enterprises and not-for-profit companies.

Shadow Health Secretary Andy Burnham said: “These figures show a two-tier NHS is taking place before our eyes and is accelerating.

“At a time when waiting lists are rising, hospital trusts are doing more and more private work.”

He said 50 hedge funds with investments in private health had given more than £20million to the Tories.

“Privatisation will drive a deeper and deeper wedge between the well-offs and ‘boys clubs’ running and supposedly serving the UK and ‘Joe Bloggs’ (working class, vulnerable elderly and disabled people).

Doctors, solicitors, lawyers etc are not going to miss out – are they? – sour grapes – dead right”