If you wake up with worrying symptoms, the anxiety of getting through to book a GP appointment or hearing that the wait is two weeks long is the last thing you need. As we celebrate the 70th birthday of the NHS this week, the world’s largest publicly funded health service has announced the launch of an app that should make such dread melt away. It will allow patients to look at their records, order repeat prescriptions and access 111 online for urgent medical queries. The app also addresses longer-term concerns, such as determining preferences for end-of-life care and organ donation, as well as data-sharing. While this will primarily help patients self-manage their care, the app will also relieve some of the burden from frontline staff. Trials with begin in September, with roll-out (across England) expected in December.
At Future Advocacy, we analyse new trends and developments in terms of the risks and benefits they may present. Whilst Health Secretary Jeremy Hunt lauded the app as the world’s first, he also noted that despite other industries such as retail and banking embracing technology, healthcare has been a little slower on the uptake. This app is therefore a sign of the NHS’s eagerness to leverage technology in improving patient care. It also offers an opportunity to collect data, which can be used to identify patient preferences and gaps in the service.
However, the app itself does not deal with the concerns of those at the frontline of the NHS, namely staff shortages, an ageing population, reductions in social care budgets, and the consequences of unhealthy lifestyles. As a primary point of contact, GP surgeries are responsible for determining what ongoing care patients need. It remains unclear how the app will help people avoid making unnecessary bookings, for example where a visit to the pharmacist would suffice. One GP has spoken of patients visiting her surgery over the Christmas period as a result of overindulgence and consequent indigestion. Last year, Dr Chaand Nagpaul, the new head of the British Medical Association, stated that a quarter of GP appointments are avoidable.
Moreover, some of what the app has to offer is already available. The NHS 111 helpline can connect the caller to a nurse, emergency dentist or GP, and can arrange an appointment or ambulance. DoctorLink encourages patients to use a ‘symptom checker’ which tells them if they need to see a pharmacist, GP or call 999. Boots Pharmacy works with GPs for ordering repeat prescriptions and notifies patients by text message when their medication is ready to be collected. Babylon Health provides round-the-clock GP access. The Evergreen Life apps allow patients to view their medical records. Nevertheless, the NHS brand may be a key characteristic in encouraging patients to utilise the app, because public trust in the institution, as one that works for the public benefit, is high.
A survey of more than 500,000 patients in Scotland for 3 years from 2013-2016 using NHS data, revealed that 46% of patients missed one or more GP appointments per year. Those patients who struggled to attend appointments had high levels of social and health vulnerability. This suggests that in addition to an app that facilitates booking appointments as a first step towards getting care, positive strategies to support attendance are just as crucial. This too could be provided via an app, for example by ‘nudging’ patients as their appointment draws nearer.
The introduction of a technology, especially in the healthcare setting, cannot be done without examining which populations are likely to find it easier to access the technology than others. Owning or having access to a smartphone is a prerequisite for using an app. 96% of 16- to 34-year-olds reported owning a smartphone in 2017. However, smartphone adoption among 55- to 75-year-olds was much lower at 71%. As we highlighted in our recent report, Ethical, Social, and Political Challenges of AI in Health, it is not always intuitive who is most likely and able to use digital tools, and who might be excluded from them. It is assumed, for example, that limited digital literacy may dissuade older people from engaging. Conversely, Jacob Lant, Head of Policy and Public Affairs at Healthwatch England, has pointed to research suggesting that older people are more familiar with the health service and therefore more comfortable with using a range of tools, compared to younger people who use healthcare services less, and therefore seek human interaction when they do.
While the launch is reflective of a tangible drive to increase patient empowerment and autonomy with the help of technology, there are cases where an app is simply inadequate. For example, many elderly people have multiple chronic conditions, but often also turn to their GP as a result of social isolation. 1.1 million people over 65 are chronically lonely in the UK, which puts them at higher risk of developing heart disease, depression and dementia. It is therefore important to understand which population groups are more or less likely to benefit from a tool and in particular, whether it will improve the healthcare access and outcomes of vulnerable populations at all.
This is not to say that apps are not a helpful tool for both patients and the NHS. They are already used to incentivise healthier behaviours, which can help maintain a fitter population and consequently lower the need for medical intervention. Furthermore, armed with app- or wearable-derived data, patients could be entering the GP practice as an equal partner with their healthcare practitioner, rather than as a passive recipient of information and advice. However, the objective of a tool should always be to address a clearly defined problem, rather than to offer a shiny, but limited, solution. We wish the NHS a very happy birthday. Once it’s done unwrapping its presents, perhaps it will surprise us with more targeted, albeit less shiny tools.
Nika Strukelj