Dr Ollie Hart works at Sloan Surgery in Heeley in Sheffield. The surgery has been part of the Widening Digital Participation in Health programme run by Tinder Foundation for NHS England. Sloan Surgery has teamed up with local Online Centre Heeley Development Trust to run a ‘digital surgery’ on site, which has seen nearly 300 people get a bit of help to find online health information over the last three years.
Dr Hart says: “Speaking as a GP, I believe digital health is a really important part of the healthcare jigsaw. It has the potential to drive up the quality and efficiency of what we do as Doctors, and it can really empower patients to start taking an active role in their own health and wellbeing.
“At my practice, we’ve been running a digital surgery alongside our normal healthcare for three years. In that time hundreds of patients have been referred on to get help to use computers and the internet – and find out more about their health.
“For instance, I might see someone with arthritis, and refer them on for an appointment at the digital surgery with someone from our local Online Centre. They’ll book a slot at reception, and come back to spend a bit more time looking at the basics on NHS Choices, perhaps the support available from Arthritis Research UK, and even more detailed decision aids to help them make informed choices about their future care.”
Dr Hart sees enabling patients to get information about their health as an important part of his job. He continues: “Being able to direct patients to sources of further information that they can absorb in their own time is essential, and there are huge resources in the digital sphere that people can tap into. Some people will be very good at digital stuff and will automatically go and get on with things, but for others there’s a barrier – they might not have the skills or confidence to use online resources and need someone to introduce them to it, signpost them to the right places that are good and safe for them – or to sit beside them and help them make sense of it.
“The digital surgery has been particularly useful for the people we see with long-term health conditions – things they’ll be living with and have to learn to manage for the rest of their lives, like diabetes, depression, chronic pain or arthritis. I’ve only got ten minutes – perhaps twenty – with a patient, and that’s often not enough time to answer all the questions or go through all the options.
“That used to mean squeezing in extra time, making repeat appointments, or sending someone away with leaflets or a list of websites. People tend to want to say ‘yes’ to Doctors, so if you ask ‘are you online’ they might well say ‘yes’ and not follow up on that information. That ends up not doing anyone any good. The digital surgery has given us another route, and it’s proved as effective as it is popular.
“When people come back to see me, they’ve got a better idea of what they’re facing and how they want to proceed – and that’s great for me. I can make the diagnosis and suggest some treatment options but actually it’s not up to me to make the judgement about what comes next. As Doctors we’re no longer the guardians of knowledge or the dictators of treatment. I might know the medical bit – but I don’t know about the rest of someone’s life, their priorities and pressures. A GPs job is very much to work with patients to achieve the best possible result for each individual. The more active people are in their own health and healthcare, the easier that job becomes.
“At the end of the day, someone’s health is health determined only to a degree by their diagnosis. Doctors don’t control your health – the person with the biggest influence on your health is you! And how confident, skilled and knowledgeable you are about your body and your choices is absolutely key. I think online resources can help people gain that knowledge and confidence – what we sometimes call patient activation – and that makes a huge difference to how someone’s overall health and wellbeing develops.
“Often, a diagnosis like diabetes is actually a golden opportunity to engage someone in their own health, and encourage them to take charge of it. The diabetes pathway for someone who has the knowledge, skills and confidence to manage it looks very different to the pathway for someone who is overwhelmed, in denial, feeling helpless and out of control. And the end result is very different too.”
The traditional Doctor/patient relationship was one with a distinct power imbalance – an authoritarian Doctor dictating to a passive patient. But as Dr Hart points out, it’s partly the digital world that has changed that relationship – everything he ever learned as medical school is now on the internet somewhere. Today, the value he adds is experience and expertise, but the patient’s own thoughts, goals and engagement are really the starting point to what’s now very much a partnership.
“I think one of the bits Doctor’s have been missing in the past is the difference it can make in how well someone is ‘coping’ with their disease,” explains Dr Hart. “That’s where digital skills and digital health can come in. And sometimes, the results aren’t necessarily what you were expecting! Increasingly we’re seeing the value added to patients from ‘social prescribing’. So I’ll send someone along to the digital surgery to find out more information about their depression. But when they come back they’ve gone way beyond the basic resources on NHS Choices – they’ve found a walking group or a knitting group or other local support that’s helping them manage or cope with their condition in a completely different way.
“I have one patient who paints, and as long as she’s painting I know she’s on top of her depression. It’s actually an important part of her health care. The internet can link people to that kind of resource, and open up new options, social circles and new worlds to people.
“At this practice, I’ve been a real enthusiast for digital health, because I can see how it transforms the way we think about giving information, supporting wellbeing and encouraging patient activation. What’s been really interesting is seeing how my partners and colleagues have reacted to it. The consistently strong feedback from patients who’ve been through the digital surgery has meant nearly everyone here now refers patients along to it, and that’s a great result. As a team, we’ve found that people come out more confident and more engaged, and overall it’s improved the quality of our consultations, and made our jobs easier and more enjoyable.
“Digital health isn’t instead of consultations, it goes alongside what we already do. Digital is a great platform supporting us to make sure patients get good information when they need it. I’d say to other GPs that the world is changing, and digital resources can be a fantastic part of the jigsaw of healthcare we deliver – helping to empower patients. Health is about choices – whether to walk or take the car. Whether to pick up a sugary treat or a healthy yoghurt for pudding. Digital is just another choice for people, and one that can actually make their lives better and more convenient. By embracing that we make life easier for ourselves, and outcomes better for our patients.
“Ultimately, I believe the sustainability of the NHS is not only about increasing Doctors and nurses – or even increasing investment – to my mind it’s also got to be about increasing the capacity of patients. If we can get someone to do things for themselves, take charge of their own health and work in partnership with their Doctor to improve it, we’re actually taking pressure off frontline services and improving the quality of our care at the same time. That’s the real potential for digital health. And with local support from trusted intermediaries like UK online centres, GPs can make it work for practices and patients right now.”