The changing NHS across the years: how technology has affected general practice – guest blog by Mark Purvis

Article posted on 30th May 2019

Health and social care

I fell in love with general practice on my first placement in Hull. Many of the patients we saw faced unimaginable difficulties but the GP I was placed with didn’t give up on anyone and always tried to do something to make things better. I realised that was the type of doctor I wanted to be.

Having worked as a GP in Bradford for 35 years, I’ve seen a lot of changes across the NHS and experienced the effects these changes have had on general practice. The health service is ever-changing. Jamie Bahrami, who was doing things in GP education in the 80s that were well ahead of his time, was a huge influence in my early career. However, the introduction of technology has seen some of the biggest transformations to the health service that I experienced.

Acceptable in the 80s

When I started working as a GP in the 80s I could have appointments every five minutes in an afternoon or evening session, a sit and wait morning surgery and be on call overnight. In some cases this would result in seeing 100 patients a day, which would involve lots of notes to carry and update along with lots of travelling. With the lack of mobile phones and patchy pager reception, I would often get home to find my wife had taken another call while I was out so I’d be straight off again. Because it’s so much easier to stay up-to-date now the amount of back and forth travelling for GPs has been reduced so we can get to our patients faster and more easily.

Things were much more clunky and took much longer in the early stages of my GP career. The old Lloyd George files were a prime example of this. To get documents to fit into the folders you often needed a black-belt level of skill in origami. The folders were often large and bulky which made them difficult to store, difficult to share and difficult to search through to find the relevant notes for each individual patient interaction. Now, with notes being digitised those processes are faster, simpler and easier which all adds up to an improved patient experience and more accurate patient care.


The first steps

I introduced the first computer into our practice in 1989. Our practice manager sewed a dust cover to protect it and our receptionist could be seen giving it a wide berth for the first few months. But even then I could see that once we got past the initial up-front work of getting everything set up and coded, it was going to transform the way we worked - and it did. That first computer revolutionised repeat prescribing for us and significantly reduced transcription errors. It also gave us a chance to make some early steps around auditing and assessing the quality of what we were already doing so that we could make more informed improvements. 


An improved quality of care

Continuity has always been a key element of general practice and has often been one of its highlights too thanks to repeated episodes of care from a single clinician. Although at times, before some of the technological improvements came into play, I did feel as though some patients were being short-changed on the quality of their care due to pressures in the service. Much of the technology that’s been introduced over time has gone a long way to improving continuity on three levels – longitudinal, vertical and horizontal.


Longitudinal continuity

Now, instead of drawing on the personal continuity developed through prior knowledge there’s a larger focus on good note keeping and the sharing of patient data. Because patient information is now stored digitally it’s much easier to access and share patient data with relevant clinicians than it was back when we were relying on Lloyd George files.


Vertical continuity

In the early stages of my career I often had strong connections with hospital colleagues as we’d have shared lunches during our postgraduate education. But, as the method of education changed and there were fewer shared experiences between sectors these connections began to decrease. However, recent NHS focus on integration and the introduction of more technology designed to link departments and sectors has somewhat helped to improve that. The more we use shared clinical records the better the continuity of care between primary and secondary, community and social care will be.


Horizontal continuity

The introduction of technology has provided a better situational awareness which hugely helps clinicians across an organisation communicate and manage patient care more effectively. Now, we can track patient and staff actions and interactions and receptionists can screen messages so that GPs only need to deal with urgent and relevant requests or queries. The GPs can therefore spend more time with patients with complex conditions and in urgent need of attention.

As clinicians, the way we manage the knowledge and information we have to hand about patients is crucial to good continuity of care and technology has had a massive impact on this. As technology has developed, it’s helped to improve continuity and therefore improve the quality of care received by patients. In my career I noticed a significant improvement in prevention and the management of chronic diseases as different care teams began to work more as one.


Future possibilities

The ability to use algorithms to support medical decision making has been transformative, and with the development of artificial intelligence (AI) the potential is even greater. As AI improves and develops further the results these algorithms provide will become even more accurate and reliable, which is invaluable to us as clinicians and to our patients.

Being able to transfer the power of managing an individual’s health to the patient themselves has also been extraordinary. The more we continue to do this through technology such as Patient Access and the more we encourage self-care techniques, the more we’ll be able to focus energy and resources on treating the most complex and urgent cases.


Always supported by colleagues

Throughout my career, the one thing that has never changed has been the amazing support between colleagues. Even without the technology to communicate through, support from other colleagues both in primary care and in education has always transcended professional boundaries in a way that I found deeply meaningful. Hopefully, as more technology develops to improve communications, this support will continue to strengthen. And, with greater communication and information sharing we can really transform the quality of care in general practice.

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