Tag Archives: GPs

An app a day … how m-health could revolutionise our engagement with the NHS

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It seems like almost every day now we see in the news and read in newspapers about the increasing pressures on our NHS, strains on resources and the daily challenges facing already overworked GP staff.

Mobile health applications (m-health apps) are increasingly being integrated into practice and are now being used to perform some tasks which would have traditionally been performed by general practitioners (GPs), such as those involved in promoting health, preventing disease, diagnosis, treatment, monitoring, and signposting to other health and support services.

How m-health is transforming patient interactions with the NHS

In 2015 International Longevity Centre research found some distinct demographic divides on health information seeking behaviour. While 50% of those aged 25-34 preferred to receive health information online, only 15% of those aged 65 and over preferred the internet. The internet remained the favourite source of health information for all age groups younger than 55. And while not specifically referring to apps, the fact that many people in this research expressed a preference to seek health information online indicates that there is potential for wider use of effective, and NHS approved health apps.

A report published in 2019 by Reform highlighted the unique opportunity that m-health offered in the treatment and management of mental health conditions. The report found that in the short to medium-term, much of the potential of apps and m-health lies in relieving the pressure on frontline mental health services by giving practitioners more time to spend on direct patient care and providing new ways to deliver low-intensity, ongoing support. In the long-term, the report suggests, data-driven technologies could lead to more preventative and precise care by allowing for new types of data-collection and analysis to enhance understandings of mental health.

M-health, e-health and telecare are also potentially important tools in the delivery of rural care, particularly to those who are elderly or who live in remote parts of the UK. This enables them to submit relevant readings to a GP or hospital consultant without having to travel to see them in person and allowing them to receive updates, information and advice on their condition without having to travel to consult a doctor or nurse face-to-face. However, some have highlighted that this removal of personal contact could leave some patients feeling isolated, unable to ask questions and impact on the likelihood of carrying out treatment, particularly among older people, if they feel it has been prescribed by a “machine” and not a doctor.

Supporting people to take ownership of their own health

Research has suggested that wearable technologies, not just m-health apps, but across-the-board, including devices like “fitbits”, are acting as incentives to help people self-regulate and promote healthier activities such as more walking or drinking more water. One study found that different tracking and monitoring tools that collect and analyse health and wellness data over time can inform consumers of their baseline activity level, encourage personal engagement in health and wellbeing, and ultimately lead to positive behavioural change. Another report from the International Longevity Centre also highlights the potential impact of apps on preventative healthcare; promoting behaviour change and encouraging people to make healthier choices such as stopping smoking or reducing alcohol intake.

Home testing kits for conditions such as bowel cancer and remote sensors to monitor blood sugar levels in type 1 diabetics are also becoming more commonplace as methods to help people take control of monitoring their own health. Roll-outs of blood pressure and heart rhythm monitors enable doctors to see results through an integrated tablet, monitor a patient’s condition remotely, make suggestions on changes to medication or pass comments on to patients directly through an email or integrated chat system, without the patient having to attend a clinic in person.

Individual test kits from private sector firms, including “Monitor My Health” are now also increasingly available for people to purchase. People purchase and complete the kits, which usually include instructions on home blood testing for conditions like diabetes, high cholesterol and vitamin D deficiency. The collected samples are then returned via post, analysed in a laboratory and the results communicated to the patient via an app, with no information about the test stored on their personal medical records. While the app results will recommend if a trip to see a GP is necessary, there is no obligation on the part of the company involved or the patient to act on the results if they choose not to. The kits are aimed at “time-poor” people over the age of 16, who want to “take control of their own healthcare”, according to the kit’s creator, but some have suggested that instead of improving the patient journey by making testing more convenient, lack of regulation could dilute the quality of testing Removing the “human element”, they warn, particularly from initial diagnosis consultations, could lead to errors.

But what about privacy?

Patient-driven healthcare which is supported and facilitated by the use of e-health technologies and m-health apps is designed to support an increased level of information flow, transparency, customisation, collaboration and patient choice and responsibility-taking, as well as quantitative, predictive and preventive aspects for each user. However, it’s not all positive, and concerns are already being raised about the collection and storage of data, its use and the security of potentially very sensitive personal data.

Data theft or loss is one of the major security concerns when it comes to using m-health apps. However, another challenge is the unwitting sharing of data by users, which – despite GDPR requirements – can happen when people accept terms and conditions or cookie notices without fully reading or understanding the consequences for their data. Some apps, for example, collect and anonymise data to feed into further research or analytics about the use of the app or sell it on to third parties for use in advertising.

Final thoughts

The integration of mobile technologies and the internet into medical diagnosis and treatment has significant potential to improve the delivery of health and care across the UK, easing pressure on frontline staff and services and providing more efficient care, particularly for those people who are living with long-term conditions which require monitoring and management.

However, clinicians and researchers have been quick to emphasise that while there are significant benefits to both the doctor and the patient, care must be taken to ensure that the integrity and trust within the doctor-patient relationship is maintained, and that people are not forced into m-health approaches without feeling supported to use the technology properly and manage their conditions effectively. If training, support and confidence of users in the apps is not there, there is the potential for the roll-out of apps to have the opposite effect, and lead to more staff answering questions on using the technology than providing frontline care.

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Mobilising healthy communities: Bromley by Bow Health Partnership

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Ian Jackson of the Bromley by Bow Health Partnership was the guest speaker at the first Glasgow Centre for Population Health (GCPH) seminar series of the year.

The Bromley by Bow Health Partnership (BBBHP) is a collaboration between three health centres and other non-primary care partners in the Tower Hamlets area of London. The aim of the partnership – and the new primary care delivery model which comes with it – is to transform the relationship between the public and primary health care. This means considering the wider determinants of health when the partners plan and deliver care, rather than treating healthcare in a purely biomedical way.

Edited image by Rebecca Jackson. Map via Google Earth

Edited image by Rebecca Jackson map via Google Earth

Effect of social determinants on health

In the 1890s Charles Booth created a map of London which categorized areas of the city of London depending on their levels of deprivation. The most recent Indices of Multiple Deprivation Report showed that those same areas considered deprived in the1890s are still facing the highest levels of multiple social deprivation and health inequality today. It is no secret that disadvantage has a negative impact on people’s ability to make the best choices when it comes to health. And disadvantage at a social level can have a significant influence on poor physical and mental health across a range of conditions.

More recent research conducted by Michael Marmot looked more closely at what determines health outcomes in populations, and the extent to which other factors influence people’s health, or rather their ability to be well.

He produced what is known as the 30/70 model: 30% of what determines your health is your genetics and improvements in pharmacology, the other 70% is related to other “external factors” including poverty, environment, culture, employment and housing. BBBHP has used this as the foundation for their primary care model, arguing that primary care providers are not just dispensers of medical products, but have a responsibility to contribute to people living healthier lives in their community.homeless

Social prescribing

One issue highlighted by the BBBHP was the significant number of people presenting at GP surgeries with “non-medical” ailments, or medical ailments triggered by “non-medical stimulus”. People were arriving at the practices and booking appointments because they were lonely and it gave them somewhere to go. Others were presenting with symptoms of depression, which on further investigation were found to have stemmed from issues around debt or domestic violence. A social prescribing service was set up by the partnership to try to tackle some of these non-medical conditions and improve the health of the general population by non-pharmacological means.

The social prescribing service, where GPs refer people to other local services for help, can be used as a replacement for pharmaceutical interventions, or be supplementary to them. GPs, or other primary care staff, may refer any adults over the age of 18 to one of over 40 partnership organisations. These range from walking groups to formal sessions with advisors in debt or domestic violence agencies, as well as art classes, community gardens and companionship services to combat loneliness. The organisations can provide help and advice on issues such as employment and training, emotional well being and mental health.Ölfarbe

The challenges of quality and funding

Maintaining quality in the provision of social prescribing is a particular challenge for BBBHP. They work regularly with trusted partners, particularly the Bromley by Bow Centre. However, there is no consistent quality check for many of the services from the health partners themselves. Evaluative studies and feedback sessions are used to assess quality and impact, and consider the scale of demand. And while it is acknowledged that more formal frameworks for assessing quality and impact of social prescribing services are preferred in formal assessments, in reality, word of mouth, participant feedback and uptake rates are used as a standard for quality as much as official feedback in a localised community setting.

A second issue is funding. BBBHP identified that finding long term funding was their main issue in providing security for providers and service users, as well as for GPs referring to services. Funding is vital not only to ensure the survival of the community groups who provide some of the referred services, but also to allow them to develop longer term partnerships and build capacity within the social prescribing service. The BBBHP works closely with the Bromley by Bow Centre, a key provider of support services for the local community, but like many services which rely on funding, they increasingly have to plan for tighter budgets.

blue toned, focus point on metal part of stethoscope

A final challenge for the staff at BBBHP was changing people’s expectations of primary care, and what it means to live well. Some patients were suspicious and reluctant to be recipients of “social prescription”, as this did not fit with the traditional expectation of what GPs should do to make people well. This can be a big change in mindset for some people, according to Ian Jackson, when people come expecting to be prescribed antidepressants but are instead “prescribed” a walking club or a debt advice service. He noted that the reaction from patients can sometimes be confused or hostile, and some patients do not even turn up for referrals.

Improving patients’ understanding of the benefits of social prescription, ensuring people attend referral appointments, and that social prescriptions have a long term impact is something which BBBHP are hoping to research further. They feel that looking at the long term impact of non-pharmaceutical interventions and how these feed back into the wider agenda of tackling inequalities is important to allow the partnership to continue to build healthy communities and save on primary care costs in the long term.

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Creating positive social connections to improve community health

Social prescribing and other associated projects have sparked new social connections. Members of the community have come together to form their own support groups. The Children’s Eczema support group run by local GPs and the DIY health scheme, which sought to educate and support parents who were anxious about minor ailments in children, have helped parents in the area to set up WhatsApp groups, organise coffee mornings and go to one another for support. Such initiatives are regarded by BBBHP as important in tackling wider, systemic social inequality in the area.

Currently, primary health care in communities is focused on illness. This needs to change, according to BBBHP, with local community-based health delivery based as much around social health as biomedical issues. Through its social prescribing and other services BBBHP has aimed to focus on supporting people in a holistic way, tackling health inequalities as well as biomedical illness, to allow them to make good choices to improve their health.

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Social prescribing – just what the doctor ordered?

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blue toned, focus point on metal part of stethoscope

By Heather Cameron

It is widely acknowledged that wider social, economic and environmental factors have a significant influence on health and wellbeing. According to recent research only 20% of health outcomes are attributable to clinical care and the quality of care while socioeconomic factors account for 40%.

With increasing pressures on GPs and lengthy waiting times a real issue for many, particularly those with mental health conditions, social prescribing could represent a real way forward.

The government clearly recognised the importance of social prescribing in its new deal for GPs announced earlier this year, which made a commitment to make social prescribing a normal part of the job.

In response to a recent Ask-a-Researcher request for information on different approaches in social prescribing and evidence of what works in the UK, it was interesting to find that despite the recognition of potential value, there has been little evaluation of social prescribing schemes to date.

Much of the material found focused on specific interventions and small-scale pilots and discussion around implementation. A new review of community referral schemes published by University College London (UCL) is therefore a welcome addition to the evidence base as it provides definitions, models and notable examples of social prescribing schemes and assesses the means by which and the extent to which these schemes have been evaluated.

So what is social prescribing?

Social prescribing means linking patients with non-medical treatment, whether it is social or physical, within their community.

A number of schemes already exist and have included a variety of prescribed activities such as arts and creative activities, physical activity, learning and volunteering opportunities, self-care and support with finance, benefits, housing and employment.

Often these schemes are delivered by voluntary, community and faith sector organisations with detailed knowledge of local communities and how best to meet the needs of certain groups.

Social and economic benefits

Despite a lack of robust evidence, our investigation uncovered a number of documents looking at the social prescribing model and the outcomes it can lead to. Positive outcomes repeatedly highlighted include:

  • improved health and wellbeing;
  • reduced demand on hospital resources;
  • cost savings; and
  • reduced social isolation.

According to the UCL report, the benefits have been particularly pronounced for marginalised groups such as mental health service-users and older adults at risk of social isolation.

A recent evaluation of the social and economic impact of the Rotherham Social Prescribing Pilot found that after 3-4 months, 83% of patients had experienced positive change in at least one outcome area. These outcomes included improved mental and physical health, feeling less lonely and socially isolated, becoming more independent, and accessing a wider range of welfare benefit entitlements.

The evaluation also reported that there were reductions in patients’ use of hospital services, including reductions of up to a fifth in the number of outpatient stays, accident and emergency attendances and outpatient appointments. The return on investment for the NHS was 50 pence for each pound invested.

Similarly, the Institute for Public Policy Research (IPPR) has recently argued that empowering patients improves their health outcomes and could save money by supporting them to manage their condition themselves.

IPPR suggests that if empowering care models such as social prescribing were adopted much more widely throughout the NHS we would have a system that focused on the social determinants of health not just the symptoms, providing people with personalised and integrated care, that focused on capabilities not just needs, and that strengthened people’s relationships with one another.

Partnership working

With a continued policy focus on integrated services and increased personalisation, social prescribing would seem to make sense. In addition to providing a means to alternative support, it could also be instrumental in strengthening community-professional partnerships and cross-collaboration among health, social and other services.

The New Local Government Network (NLGN) recently examined good practice in collaboration between local authorities, housing associations and the health sector, with Doncaster Social Prescribing highlighted as an example of successful partnership working. Of the 200 referrals made through this project, only 3 were known to local authority and health and wellbeing officers, showing that the work of social prescribing identified individuals who had otherwise slipped through the net.

And with the prospect of an ageing population and the health challenges this brings, a growing number of people could benefit from community-based support.

As Chair of Arts Council England, Sir Peter Bazalgette, notes “social prescribing is an idea whose time has come”.

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Further reading: if you liked this blog post, you might also want to read Heather’s earlier post on the health and wellbeing benefits of investing in public art.