The doctor won’t see you now: plan to save the NHS by reducing face-to-face care Plans to shake up health services and save the NHS millions hinge on patients either not getting ill in the […]

Plans to shake up health services and save the NHS millions hinge on patients either not getting ill in the first place or looking after themselves with an increased use of technology.

Health bosses around the UK are drawing up plans to shake up the patient-doctor relationship by limiting “face-to-face” interactions, both in the NHS and in drastically under-funded council-run social care.

i’s investigation into proposals to remodel the health service reveals plans to use apps, monitoring devices and video-link surgeries to bridge a £22bn funding gap by 2021 .

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The analysis by this newspaper and sister Johnston Press titles has found all 44 Sustainability Transformation Plans (STP), produced by regional NHS bodies, will propose to meet strict five-year savings targets by increasing the use of new digital technologies to deliver health services.

Virtual appointments

Regions are proposing to increase “virtual appointments,” where patients can talk to their GP, or take part in a group therapy session via video-call.

“Artificial intelligence” apps are already starting to deliver diagnoses on the private market and are being discussed by NHS Clinical Commissioning Groups looking to assess patients without a face-to-face meeting.

Campaigners, however, argue that patients will suffer if health bosses try to replace frontline medics with apps. Nor are leading GPs convinced the move is the magic formula in helping the NHS meet its £22bn shortfall.

Workload

Helen Stokes-Lampard, chairman of the Royal College of GPs, believes video-link doctors’ appointments could increase their workloads.

She said: “While these might be convenient, they don’t actually reduce a GP’s workload as a 10-minute patient consultation takes 10 minutes whether face-to face-or over the phone – and in some cases virtual consultations can increase workload, if a follow up face-to-face consultation is necessary.”

Mrs Stokes-Lampard says she broadly supports the idea of increasing technology in the NHS, but she fears it could alienate patients who are not “tech savvy”.

“Whatever happens, the GP-patient relationship is unique in medicine and there is no app, algorithm or technological innovation that can, or will, replace it in the foreseeable future,” she said.

More ‘telecare’

In adult social care the STPs talk of increasing “telecare,” where elderly or disabled people can be monitored by devices in their own home.

One union leader fears the approach, which campaigners fear is a move for cash-strapped councils to reduce home visits, is flawed.

Guy Collis, health policy officer at the public service union Unison, said new technology would require staff to undergo extensive, costly training.

“I think too often there’s this idea that it can be a quick shortcut for savings or improving patient experiences,” he said. “That’s all well and good as long as you have the right people.

“The NHS doesn’t have a great track record for IT”, he said.

The move is inevitable

But Madeleine Starr, director of innovation at national charity Carers UK, said the move to self-administered healthcare is “inevitable” considering the huge NHS deficit.

Patients, she believes, will simply need to adjust.

“We need to move away from the idea that a GP is a sacred cow you’ve got to sit in front of,” she said.

“You are never not going to need an expert when the time comes. But very often the GP is not providing expert support.”

Carebots

Mrs Starr believes new innovations in home “telecare” will be key to reducing the workload of carers.

The UK, she says, is languishing behind other developed nations, such as Japan, which is already rolling out “carebots” that can detect falls , assist mobility and provide company.

An NHS England spokesman said: “GPs and patients are voting with their feet, and in Birmingham, Wakefield and north London are now offering skype consultations and online advice. Of course, GPs need to offer convenient face-to-face appointments, but it would be stupid to turn our back on new technologies.”

Home alarms and other technology help trim budgets Home alarm systems such as buzzers attached to a lanyard worn around the neck and toilet pull cords have been a feature of the home care market. They provide peace of mind to family and friends by allowing elderly and infirm people to raise the alarm should they fall or have another accident at home by pressing the buzzer or pulling a cord, which alerts a call centre who holds the phone number of carer and who can call the police or amubulance if necessary. However, the brand names behind such technology, including Canary, Oysta and JustChecking, now say they can offer much more. Cash-strapped councils, which have the responsibility for looking after vulnerable adults and the elderly in their areas, are keen to increase their use of monitoring technology.

Hampshire County Council is in the vanguard of using such technology. It claims to have trimmed £4.7 million from its budget since entering into a telecare partnership with London-based PA Consulting. Northamptonshire County Council, which is set to cut £24 million from its 2017/18 adults care budget alone, is preparing to put more Canary devices in homes. These monitor movement, temperature and light and relay the information to a computer. A text or email is sent to alert anything unusual. In Milton Keynes, Bedfordshire and Luton, the STP for the area budgets for a £12 million “digital investment” over the next five years. Aside from the savings Editor of OurNHS, OpenDemocracy, Caroline Molloy says GPs have deep concerns that a move away from “face-to-face contact with a GP will see patient’s ailments missed. She said: “The real thing they worry about comes out of that lack of human interaction. “I’ve had people who are strong advocates of this sort of thing admit they are worried. As soon as you are not seeing someone in a room in front of you – you are losing out on their skin colour, their smell, whether they are looking after themselves properly, whether they are tapping their foot under the table because they are not giving you the full picture. “All of these little clues are really important.” She also believes the sheer capital costs needed to invest in the new software could negate any savings benefit as well.

Reducing admissions

All 44 STPs are seeking to drastically reduce accident and emergency admissions, scheduled visits and “face-to-face” care in part, by moving towards a model of what has been labelled “self care”.

Vice-president at the Royal College of Emergency Medicine, Chris Moulton, believes types of preventive treatment are “absolutely the morally and medically correct thing to do.”

But he warned they should not be used as a way of saving the NHS money.

He said: “When a 60-year-old person takes statins and other drugs to avoid having a heart attack, they don’t sign a pledge saying that they will never use the health service again for the next two decades.

Lifestyle changes

“Using lifestyle changes and medical interventions to prolong happy lives is the right thing to do. But it is not the answer to the financial crisis facing the NHS.”

But the jury is also out on the effectiveness of apps that used to remotely monitor people with mental health conditions.

Scientists at the University of York said a trial of mood-monitoring therapy software, where patients update a system with how they are feeling at a given time, showed it offered “little or no benefit over usual GP care,” as many users were not willing to log in of their own accord.