Digital health: Are we transforming the NHS or merely digitising what’s there?

Drawing on his experience as a health minister and chair of the Health and Social Care Select Committee, GK’s strategic advisor Steve Brine examines the government’s ambition to shift the NHS from analogue to digital, arguing that its success will depend on whether technology genuinely transforms care and reduces frontline pressures, rather than simply digitising how patients access them.

The Labour government has made ‘analogue to digital’ one of the defining ambitions of the10-Year Health Plan. It is difficult to argue with.

A next-generation NHS App, (finally) a Single Patient Record, greater use of AI and digitally enabled neighbourhood health all offer the prospect of a service that is easier to navigate, more personalised and – whisper it – more productive.

Given the pressures facing the NHS workforce and public finances, technology is no longer an interesting addition to health reform; it is central to whether much of that reform can actually be delivered. Jim Mackey, Chief Executive of NHS England, believes this to his core.

But there is an important question underneath all this ambition: how deliverable is it in practice, and are we moving further away or getting closer since the change of personnel in government?

For most people, their interaction with the NHS happens through primary care. That means the digital NHS will ultimately succeed or fail not in Whitehall, but in thousands of GP practices, pharmacies, optometrists and other community settings.

And therein lies both the opportunity and challenge.

Digital technology should help patients reach the right service first time, automate routine administration, enable better self-management and allow clinicians to concentrate their time on people with more complex needs. Used intelligently, it can support the other great shifts the government wants to achieve too: from hospital to community and from sickness to prevention.

But there is a danger that we confuse digitising access with transforming care.

Making it easier to contact the NHS is not necessarily the same thing as reducing pressure on it. If a new digital front door simply produces more follow-up work for already stretched primary-care teams, we have made demand more efficient without making the service more productive.

That distinction seems to me, as a former minister for primary care, to matter enormously.

The real opportunity is not simply to give patients a digital route to the same services they have always used. It is to use technology to change where they go and, sometimes, whether they need to see a healthcare professional at all.

During my tenure as the minister, Pharmacy First was born of exactly that thinking and I wrote about it in a recent column. It is hugely successful but that success should give us confidence to ask the next question: is Pharmacy First an analogue service in a digital age?

Its great strength is its simplicity. You have a problem, you walk into a pharmacy and speak to a professional, often without an appointment. We must not lose that.

But today we should be able to open the NHS App, describe our symptoms and be directed towards the right destination: self-care, GP, urgent care or community pharmacy. If pharmacy is appropriate, we should be able to see which pharmacies nearby offer the service and, ultimately, which have the capacity to see us.

‘Try your local pharmacy’ is mere signposting. ‘Your local pharmacy can help you this afternoon’ is a pathway.

The same principle applies much more widely.

A patient should not need to understand the organisational architecture of the NHS before accessing it. The question should increasingly be not how do I get a GP appointment? but what is the quickest and most appropriate way for the NHS to help me?

A genuinely intelligent digital front door should help make that distinction.

This is where the government’s digital ambitions and its neighbourhood health agenda ought to come together. Digital should be the connective tissue which allows care closer to home to work, not a separate technology programme running alongside it.

The NHS App may become increasingly sophisticated, but a brilliant consumer interface sitting on top of fragmented clinical systems does not constitute a digital health service. In short, the NHS does not only have a digital-access challenge; it has an integration challenge.

There is a workforce issue here also. Digital transformation cannot simply become another set of requirements imposed upon primary care. Every new platform, pathway or form of digital access changes somebody’s working day.

For a GP practice already managing intense demand, the compelling technology is not necessarily the one with the most impressive functionality. It is the one that removes duplication, reduces avoidable contacts, automates routine processes or releases clinical time.

Perhaps that suggests a simple test for every significant piece of NHS digital transformation should be; what workload does it REMOVE, not simply what functionality does it ADD?

There is an important patient dimension too. Digital by default cannot become digital only. Some patients will continue to need telephone or face-to-face access and, for those with frailty, multiple conditions or other complex needs, human navigation may become more rather than less important.

That is not an argument against digitalisation. In many ways, it is the argument for it. If technology can deal more effectively with straightforward transactions and help digitally confident patients navigate services themselves, scarce capacity can concentrate on those who need it most.

That, ultimately, is the prize.

Digital transformation should not be an IT programme imposed upon primary care. It should be service redesign undertaken WITH primary care. And the real measure of success will not be what happens on the screen, but whether technology changes for the better what happens behind it.