NHS to sign up patients for ‘virtual’ A&E in tech revolution

This article was taken from: https://www.theguardian.com/society/2019/may/23/birmingham-to-begin-accident-and-emergency-online-chat-service-in-tech-revolution-for-nhs-care

By Denis Campbell Health policy editor

Exclusive: Patients checking systems will be told by chatbot if they need to go to hospital

Millions of patients will be encouraged to use digital technology to assess how ill they are under a groundbreaking initiative by a leading NHS hospital, as part of a drive to reduce the use of A&E and outpatient appointments.

A revolution in the NHS’s embrace of technology will see patients in Birmingham advised to use online – live and automated – chat services, online symptom checkers and video consultations with doctors and nurses to help relieve the “unsustainable” pressure on services.

University Hospitals Birmingham (UHB) trust has decided to push through radical changes that it hopes will transform how hundreds of thousands of patients a year receive NHS care and treatment.

Under their plans, people thinking about seeking help at A&E will be encouraged to instead to undertake a two-minute online check of their symptoms before they go to hospital. The “artificial intelligence triage” will then tell them if they need to seek treatment or not.

Patients will also be able to talk to their consultant using their smartphone at home or work and not have to go to the hospital itself for an outpatient appointment. Consultations done that way would be more convenient for many patients, but would mean they no longer undergo a physical assessment of their health.

UHB plans a “massive expansion” of such clinics, eventually covering every medical speciality.

Research that pollsters Ipsos Mori undertook for the Health Foundation, which was cited in the recent NHS long-term plan, found that around two-thirds of the public across all age groups are happy to have a video consultation with their own GP rather than a face-to-face appointment.

The expansion of online interaction with the NHS is likely to raise fears that the loss of face-to-face contact with health professionals could compromise patient safety.

The scheme will also spark controversy about creeping privatisation of NHS care because the trust plans to implement the changes in conjunction with a private firm, Babylon Health. It has been accused of undermining the NHS by enticing patients to stop using their usual GP practice and instead switch to its GP At Hand service, which is based on remote consultations. When patients join them, their GP surgery stops receiving annual payments from the NHS for their care, which GP groups have warned threatens the future of general practice.

More than 50,000 patients in London have already signed up to receive their GP care through GP At Hand, and NHS England has given it permission to start operating in Birmingham too. An estimated 85%-90% of patients who have their consultation that way do not go to have a face-to-face appointment with a GP, though it has surgeries where patients can do so.

UHB will use modified versions of GP At Hand’s existing technology to help it manage the growing number of patients with chronic conditions, such as diabetes and heart problems.

“The collaboration being discussed between UHB and Babylon will help outpatients, primary care and emergency care to go digital, supporting people across Birmingham and beyond to take control of their own health and avoid the hassle, expense and carbon footprint of unnecessary travel to the hospital or GP surgery,” said Paul Bate, Babylon’s managing director for NHS services. Bate has been a civil servant in Downing Street and the Cabinet Office specialising in health policy under the premierships of David Cameron and Tony Blair.

A briefing paper on UHB’s plans approved by its governing board on Wednesday states that it is forming a “collaboration” with Babylon to help it “transform the model of healthcare using technology to better manage demand”. Their talks about “areas of potential collaboration” have centred on three areas:

• virtual outpatient consultations and chronic disease management

• pre-hospital triage for unscheduled care

• referral pathways from GP At Hand to UHB services and vice versa.

UHB’s attempt to reshape the NHS’s relationship with patients will be closely studied by other trusts pondering how to deal with the increasing load on them caused by the growing, ageing population.

It will delight Matt Hancock, the health secretary, who is an avid advocate of using digital technology to make care quicker and more convenient for patients and also improving the diagnosis of illness while relieving the burden on NHS staff.