It wasn’t that long ago that IT investment in the NHS was something of a joke. Various attempts at bringing in new technology were quickly dropped and never heard of again, although one notable exception is the electronic prescription service (EPS), which, after a slow start, is now used for more than 76 per cent of prescriptions.
Fuelled by the need to achieve efficiencies, curb rising costs and meet the growing demands on care, times have changed and the NHS is now very serious about pushing ahead with digital transformation, driven by the vision of – and funding from – health secretary, Matt Hancock. The UK has aspirations to be a world leader in digital technology in healthcare.
New ways of thinking have often been slow to spread across healthcare systems, with different sectors – including pharmacy – working in isolated silos. Now a ‘digital revolution’ is being led nationally, and centrally, by the NHS, bringing the latest technology to healthcare, empowering patients, and potentially giving healthcare professionals the tools and information needed to work together far more effectively. So is pharmacy ready or could the sector find itself on the back foot in this technological revolution, amid radical thinking and new players in the market?
Within 20 years, 90 per cent of all jobs in the NHS will require some element of digital skills, predicts the Topol Review (published last month), highlighting a significant skills gap. There will also be the potential to offer personalised care to patients, requiring healthcare teams to work very differently.
“The fusion of genomics, digital medicine, artificial intelligence and robotics will enable staff working within an ethical and legal framework to deliver a more holistic approach to personalised healthcare and disease prevention,” says the review, led by Dr Eric Topol. For example, the cost of sequencing the genome is likely to decline over time and genetic diagnostics will enable more efficient targeting of medicines.
Everyone working in healthcare will need the time and willingness to explore new technology, to learn how to use it, and have education and training in place to facilitate that, the report states. “The greatest challenge is the culture shift in learning and innovation [that is required], with a willingness to embrace technology,” but mechanisms must be in place “to ensure advanced technology does not dehumanise care”. While automation will improve efficiency, it should not replace human interaction, the review says.
Chapter 5 of the NHS Long Term Plan, published in January 2019, promises that “digitally-enabled care will go mainstream across the NHS”. The Long Term Plan describes a vision of the health service working in a different way – and just a decade from now.
“In ten years’ time, we expect the existing model of care to look markedly different. The NHS will offer a ‘digital first’ option for most, allowing for longer and richer face-to-face consultations with clinicians where patients want or need it,” says the Government paper.
“Primary care and outpatient services will have changed to a model of tiered escalation depending on need… When ill, people will be increasingly cared for in their own home, with the option for their physiology to be effortlessly monitored by wearable devices. People will be helped to stay well, to recognise important symptoms early and to manage their own health, guided by digital tools.”
Key aspects of the plan include:
The NHS will work with approved providers to develop these new systems. The overall aim of this investment in technology is to create much needed capacity and long-term financial efficiencies for a creaking NHS. There is the potential for new arrangements and administrative processes to be introduced to change national and local contracting.
In other sectors, technological advance has brought disruption, with new providers and systems entering the market and taking prominence where they are found to be both useful and userfriendly. This could particularly be the case in the modernising health service, where patients (for example, those managing long-term conditions or health risks) are empowered to use new platforms such as digital apps. What is popular with patients is most likely to determine what is adopted technologically-speaking in the future.
In England, for example, PSNC has been considering pharmacy technology as a particular priority in recent months, recognising that community pharmacy should expect to be equally involved in the ‘IT revolution’.
“Matt Hancock has made technology one of his three priority areas for the NHS. He has made a number of comments on this topic, setting out his vision of an NHS which makes best use of technology to provide better care and save public money. The Secretary of State has been clear that he expects all providers of health services to embrace this approach. NHS England also encourages the harnessing of technology and innovation,” says the negotiating body.
Technologies of particular relevance to community pharmacy, PSNC says, include automated dispensing facilities, and hub and spoke dispensing; apps including artificial intelligence; and novel delivery mechanisms, as well as tele-pharmacy. In the shorter term, the recently launched NHS App offers pharmacy new opportunities to work with patients and integrate further with NHS systems, such as repeat dispensing.
With ministers continuing to show interest in the potential of automated dispensing, as well as hub and spoke dispensing, for contractors, community pharmacy needs to “lead the development of any changes,” rather than having them imposed. This is one of the topics earmarked for discussion with the Department of Health during negotiations this year.
However, with many community pharmacies without a functioning website, and some with out-dated computer equipment, a digital revolution within pharmacy may seem optimistic at the moment. And hub and spoke remains a controversial issue among parts of the independent sector.
The NHS Apps Library went live in February. It provides a place for patients and the public to find trusted and safe apps and digital tools to help improve their healthcare and take more control of their treatment. Examples include:
DIMEC: an app to order NHS repeat prescriptions
Echo: delivers repeat prescriptions free of charge; reminds patients when and how to take their medication
Healthera: connects users to an approved local pharmacy
Active 10: a walking tracker encouraging “a brisk 10-minute walk everyday”
Couch to 5K: running for beginners iPrescribe Exercise: a 12-week exercise plan
Talking Point: an online community for anyone affected by dementia
NHS Smokefree: quit smoking support
Beat Panic: anxiety support
Changing Health: ‘lose weight, eat better’
Chat Health: a confidential text messaging service
Squeezy: helps women to remember to do pelvic floor exercises.
Community pharmacy needs to respond to the work that is underway to create a technologically-focused NHS, says Chris Ellett, director of transformation at Well Pharmacy. This is not news to the sector, he says.
“The NHS and Government have been clear with community pharmacy for a number of years now that technology will play a significant part in improving patient care and experience. Patients are interacting with services outside of healthcare in their day-today life that are being enhanced by technology. There is a growing expectation that pharmacy and the broader healthcare system also need to meet these raised expectations.”
Well has been pushing ahead with a digital strategy for several years, says Ellett. “Our strategy sees technology as very much an integral part of our transformation at Well Pharmacy. Whilst our focus initially is on improving the pharmacy experience and giving customers more choice about how to get their prescriptions fulfilled, our longer-term view is to ensure that we are part of an integrated healthcare service that offers the very best care for patients,” he says.
So, what do pharmacies need to do to ensure that they are involved with future developments and not left behind?
“Face into the reality that this is happening and stop focusing on maintaining the status quo. The more the pharmacy industry embraces the changes ahead, the easier it will be to get to where we need to be to survive. Those who choose to ignore the changes that are happening do so at their own peril. We only have to look outside of pharmacy and healthcare to see the fate of businesses that have failed to adapt.” Chris Ellett believes that the healthcare system will start to see “the positive changes that other industries have already benefited from”.
A survey by the Patients Association found that 39 per cent of people would be willing to engage with artificial intelligence (AI) and robotics for healthcare. Men are more willing to use AI than women (47 per cent compared to 32 per cent) and the young have more enthusiasm to use an intelligent healthcare assistant (55 per cent of 18 to 24-year-olds versus 33 per cent of 55+ year-olds).
Awareness of the functions of the NHS App, for example, could be a good place for pharmacy teams to start thinking digital. It is likely to be popular with patients, says Ellett, giving patients the opportunity to use it to interact with their pharmacy when ordering repeat prescriptions, for example.
The app will become “one of the ways in which patients interact with the NHS”, he says. “I think choice and flexibility is so important now, so I’d fully expect other organisations to be able to build digital and technology solutions that work with and alongside the NHS App.”
Indeed, development of technology in healthcare could, finally, be the means of connecting pharmacy more effectively with primary and secondary care, says Numark’s Wayne Harrison. “Any investment in technology to improve ways of working in primary and secondary care, while helping with the patient pathway through the NHS, has to be a positive step. For too long the NHS has been behind the curve with embracing technology. The historical lack of a joined-up approach to healthcare has often had sectors working in silos with no cohesion.”
Community pharmacy must not stand on the sidelines and watch others lead developments that will impact on the sector. Pharmacy could take the lead in triage, for example, in a reworked and digitally-led primary care system, he suggests.
“Pharmacy needs to be involved. In his first speech as health secretary, Matt Hancock acknowledged that more money needs to be put into community pharmacy to ease the pressure on secondary care. Investment in the NHS App and a true ‘pharmacy first’ triage system would be a real step forward.”
Greater use of automation in pharmacy could free up time to offer new services, Wayne Harrison suggests. “It is an exciting time for the industry and technology is at the forefront of this. As we move closer to a service-based contract, we will need to free up time in the dispensing process.
Automation will be key with this. Hub and spoke, automated MDS dispensing and dispensing robots are just some of the technologies that are either here, or could be around the corner, all designed to improve efficiencies and put some time back into contractors’ days. With that time comes the opportunity to carry out additional services and earn extra revenue.”
NPA chief executive Mark Lyonette has previously said it is time pharmacy had a clear strategy for enhancing the use of technology in the sector. “There is a growing awareness that digital technology will be an increasing feature of healthcare. But there isn’t yet a shared vision of how health services should use technology to achieve efficiencies and integrated care without losing the human touch in healthcare – and it must not be at the expense of the quality of pharmaceutical care.
“The challenge is to optimise the use of technology to strengthen, not to undermine, pharmacy’s locally-based service proposition. The tried and trusted model of care provided by the bricks and mortar network of community pharmacies must be enhanced and complemented, not replaced.”
The Scottish approach Scotland’s Digital Health and Care Institute, based in Glasgow, is working on a wide range of projects, such as eHealth technologies to support hospital at home, next generation asthma care, digital decision support and technology to support active ageing.
“Community pharmacies across Scotland could make a much greater impact on the health and wellbeing of the nation if they were given the opportunity to do so,” Professor George Crooks, chief executive officer of the Digital Health Institute, told Pharmacy Magazine. “One of the ways that could act as an enabler is through the use of digital tools and services focused on allowing people to do much more for themselves at home, receiving additional personal support from their pharmacist rather than having to visit hospitals or even their GP.
“For too long the GP has been seen as the default option for community healthcare. Community pharmacists, if empowered to do so, could play a much greater role in supporting many areas of technology-enabled clinical practice. I am personally aware that there is a willingness within the profession to better understand where technologies could add real practical value in the day-today lives of pharmacists’ patients and customers.”