The rapid digitalisation of the NHS must be robust in identifying the benefits, failures, and risks of new and existing technologies, says Jane Wilcock
Recently I attended the launch of All Systems GP, the RCGP manifesto for technology enabled general practice. The NHS Long Term Plan is ambitious in its aims for NHS IT and use of technology. The plan commits to a fully integrated “digital transformation” across primary, secondary, and social care. According to the plan, patients will be able to view and contribute to their personal electronic health records and increase their understanding and control of their healthcare management decisions. In addition, every patient will have the right to online digital first access to healthcare by app, symptom checker, and virtual GP consultations with their own general practice or by another provider.
The RCGP manifesto calls for urgent investment in IT systems across general practice to enable GP practices to digitalise. The manifesto urges the government to “get the basics right” before launching a full scale digital revolution, with concerns about sustainability, cost, and safety and an acknowledgement that the basic IT needs to function better first. At the launch of the RCGP’s manifesto Hadley Beeman, chief technology advisor to Matt Hancock, the secretary of state for health and social care, announced fibre-optic broadband for all general practices and recognised that critical thinking and safety were paramount in healthcare. But what is the use of fibre-optic broadband if GPs are using computers that are outdated, take ages to start up, or freeze mid clinic? Having old technology means that GPs won’t be able to keep up with new technology updates or provide services such as electronic patient records, or online consultations. How best can we digitalise general practice while maintaining scrutiny of standards?
No system is perfect. The only way for systems to improve is if we are transparent about failings and willing to correct them. This is a cornerstone of medical professionalism. In assessing novel technology we should compare efficacy and cost not to an underfunded, understaffed NHS with glitch-ridden systems, but to present systems if optimally funded and staffed. The NHS digital systems do not currently record every IT fault nationally that GPs and patients frequently experience in their practices or NHS interactions. In order to improve existing IT systems and maintain high standards, we need to record all faults as well as the benefits of IT systems.
The functionality of other technology in the NHS requires urgent investment and quality standards. All medtech devices, including those purchased by the public, need to be registered and regulated, especially wearables, which are promoted in the NHS Long Term Plan. They need to be designed to specific medical device standards so that clinician’s equipment is not in possible conflict with patients’ readings.
Online content and patient forums that are accessed via the app library or other NHS portals need to be moderated and checked for accuracy. For each new technological “advance” the benefits and harms, particularly often ignored psychological sequelae, must be recorded. This will be important for genomic data collection as the government plans to explore and store people’s genetic codes for the possessors information and for research to improve targeted therapies and investigations. The vast increase in online data and increased access by different health specialists may increase the risks of data breaches and transparency over this is key.
The rapid digitalisation of the NHS depends on robustly identifying threats, harms, and added benefits of new technologies. As the RCGP have said, this includes putting our current house in order and applying robust safety checks to future technologies. It is important that we embrace the benefits of new technologies, but they have to be well tested, evidence based and regulated, as well as secure. Finally they must provide clear benefits to doctors and our patients.
Jane Wilcock is a GP in Salford, chair of the RCGP overdiagnosis group, and vice chair RCGPNWE faculty.
Competing interests: None declared