Boosting our way out of the backlog

The NHS long term plan contains a pledge to boost ‘out of hospital’ care and dissolve the historic divide between primary and community health services. Many members of the Pharma and Med Tech sector ask me – what does that actually mean? And how can we help it happen?

Well, as I’ve mentioned in a previous article, it all comes down to complete pathways of care. And a thorough examination of those pathways is usually where you will find a pinch point in secondary care.

That results in a backlog, perhaps in outpatients or, more commonly, in diagnostics. But if the service could be moved out of hospital – in a properly resourced way of course, you cannot just expect general practice to pick up a vast amount of work – the pressure is quite often relieved on both the hospital and the general practice.

That’s because, if the patient has not had a diagnosis and is unwell, they tend to go back to their GP over and over again, trying to either speed up an outpatient appointment or the diagnostic appointment or get some symptom relief.

And of course, more often than not the healthcare professionals in general practice can’t do any more with them, which is why they refer them into secondary care.

Time to get out of the silos

There’s a big push to boost out of hospital care and get right away from silo working, where general practice, community services, secondary care and specialist care all sit separately. It’s better for everyone involved – especially the patient – to provide seamless, integrated care.

That could mean consultants coming out of hospitals and delivering care in a host of different locations.

A single, off-the-shelf model of care for this does not exist. You have to design and develop and implement your service to meet local needs. So of course, they’re all going to differ in scale, and development and they will often be different in the way that they are delivered.

The key thing is that we should be delivering healthcare for the population, building services for what we should have – not just what we know we’ve got. In other words, we need to deliver care for those that we know have been diagnosed but also establish a system to find those patients that are out there but currently haven’t been diagnosed.

Get on the front foot

To build a system like that, you have to do four things:

  • Enhance skills
  • Redesign the workforce
  • Redesign the work
  • Get on the front foot and find the people missing from disease registers

There’s a really good example of this working in Newcastle upon Tyne. A hospital and a local GP federation came together to redesign the non-mediated IgE paediatric allergy service.

The hospital wanted to shift this out to primary care, but to do it, it meant training, developing and accrediting two GPs. The idea was tested with the GP population in Newcastle, people came forward for the training and now, six years on, that contract continues to be renewed. It has become a valued healthcare service in the city.

Enhancing skills

In terms of enhancing skills, the GPs went into the hospital’s outpatient department and worked there over a year where they were trained and accredited. One of those GPs went on to take an MSc qualification in paediatric allergy – a complete enhancing of their skills.

In terms of redesigning the workforce, the GPs were now part of the service.

And the work was redesigned. As the GPs were added to the workforce, a consultant dealt with the patient’s first appointment to establish whether their allergy was mediated or non mediated. If it turned out to be a mediated allergy, the patient stayed under the consultant’s care.

Where it turned out to be a non-mediated allergy – usually related to foodstuff (e.g., cows milk and peanuts), cat, dog, house dust mite, pollen, grass etc – that work was moved to the GP. So the whole service was based in general practice, with a consultant and a hospital dietitian working alongside a GP.

This meant no patient ever needed to be called back in because if the GP had a problem, the hospital consultant and dietitian were on site to help.

The patient gets help much earlier

This redesign meant they could start work on a population health basis and get help for the patients much earlier than before when the hospital was often left struggling with the number of referrals it was getting, leading to delays and a backlog. By increasing the capacity, it’s been able to change and shift the service.

If that works in the field of paediatric allergy, there’s no reason why it shouldn’t work in most of the other services we come across. There are many examples of it working in cardiology and dermatology departments and for patients with diabetes, heart failure, CKD, lung cancer and migraines, for example.

The challenge for the Pharma and Med Tech industry is to think about how it can get involved in those changes. What do we offer that would help us boost out of hospital care, potentially redesign services, enhance skills, redesign the workforce and redesign the workload?

There are some terrific opportunities out there – if the industry is prepared to get out and find them.

Feel free to connect with me on LinkedIn if you’d like to discuss any of the points raised in this article.

Scott McKenzie helps pharmaceutical, medical technology, and device firms increase revenue by getting their products and services in front of the right NHS decision-makersIf you want to get your products fully embedded into treatment pathways, Scott can help you. Scott and his team have doubled revenue for their clients and can share these processes with you too.