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Solving NHS pain points ‘a must’ for tech success

2 November 2023

Digital health business eConsult was founded by four GP partners to improve patient access to NHS GPs. Today its technology is live in 2,500 NHS GP practices and 10 emergency departments. Founder and chief executive Murray Ellender - still a GP - says to succeed, any tech change must address the challenges in the system – as well as the needs of patients.

General practice model needed change

I was fortunate early in my GP career to join a practice in south London that went on a growth journey – expanding from one practice to 15 sites in a short space of time.

That was when it wasn’t a trendy thing to do. Colleagues asked if we were mad. Now the consolidation of general practice is much more of a ‘thing’ and there are super-partnerships, primary care networks and GP federations.

Back then we got to a certain scale – our practices served 100,000 patients - and thought “so what?”

We believed before we grew further we needed to revise the very model of general practice. The same model had underpinned general practice for generations. If you wanted to see a GP, you attended a physical building and sat in front of a GP – and we made the process of booking to come in difficult. We knew a lot of this process could be managed remotely.

This was the motivation for us to do something with technology. Rather than keep growing and taking on more surgeries we wanted to look at technology to improve general practice. Ultimately, that’s what took me into technology.

This was 10 years ago and a lot has happened since – we have designed a process where we gather the patient’s history before they come in.

We ask the patient questions about what they need through the practice website or the NHS App. We then send that information to the clinician, who can manage the patient, often without bringing them into the building at all.

That is what's behind eConsult – and we've taken it from those original 15 practices to a third of general practices nationwide. We've done something that everyone says is impossible in the NHS: we have scaled.

We've taken our tech platform to do the same thing in different care settings. We're now in hospitals, so in an A&E you can walk in and rather than speak to a triage nurse, you arrive at a bank of iPads and they ask you who you are and why you're there.

We triage you at the device and say, “this patient is really sick and needs to be seen immediately”, or “this one is less sick and can wait.” We can also identify patients who shouldn't be in A&E at all and route them back into general practice early on in their journey.

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Murray Ellender: patient needs first

Opencast 'has been key to our journey'

Opencast has been a key part of our journey. As we've grown and scaled the business, we've expanded our engineering and product teams. We have some of the Opencast team as part of our team again now, and it’s working really well.

We also share common values with Opencast. We are a tech business that only supplies to the NHS and a lot of the people who work for us do so because we're doing something that's transforming the NHS.

There’s a lot of talk around pouring more money into the NHS. But actually there is a lot of money in the NHS – it’s just not necessarily spent in the right way.

We don't spend nearly enough on technology. The NHS far too readily says “let's spend more on people”, when actually the only thing that's going to help with productivity in the NHS is investing more in tech.

In its forthcoming report on patient-centred care, Opencast talks about the importance of the people that use health services – and that is really important. The development of our product has been very much around users of health services.

There are a variety of users – how you balance that is the challenge. There are various personas to consider - the clinician, the administrator, the practice manager, the GP, the nurse and so on.

The first of Opencast’s key principles describes putting user needs at the heart of the process. When you're designing a product or a bit of technology or system change, in healthcare you instantly think that means the patient.

When we built eConsult, we were a bunch of clinicians with an idea, but we were based in the top floor of a practice. It was actually the best location for us because it provided a live laboratory below us to test and iterate.

Our first hire was a technologist, our second was a user experience (UX) expert and she spent a lot of time downstairs in the waiting room, testing early versions with patients. That constant iteration and evolution in the early days helped us build a product that ultimately scaled.

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"We knew process could be managed remotely"

Pain point focus needed

Another of the Opencast principles articulates the need to identify problems and ask how they can be solved. Too often technology comes in with a ‘solution’ and we simply apply it rather than asking what the problem is and how we can solve it.

When we took our GP product into A&E, we took the clinical team out for two days and involved our own user experience team and technologists. Then we engaged external facilitators – the same design team who worked with BA to evolve the airline check in process. This team had shifted a process where you check in at an airline desk with a human and moved from that to a check in process at a kiosk on arrival. The next shift was to check in at home.

We applied the same principles.

When you arrive at A&E there is often a queue for someone behind a desk. Now, with eConsult, you check in on a kiosk. Next we intend to take the user experience back into the home, so you’ll be able to check your symptoms before you leave. That is a result of a product development process where we think about the problems and look at the pain points along that journey.

The NHS is good at buying technology and then just sitting on it for 20 years rather than it constantly evolving, iterating and improving. That is the same with product design – the process never ends. You get version one out, then you keep going and continue to iterate, and that's really important.

This post is an edited version of Murray’s talk at an Opencast healthcare dinner in London on 26 October.

Case study: Opencast helps eConsult scale digital health

Colour photograph of two men sitting next to each other smiling
With Opencast's Harry Armstrong at our dinner

We far too readily say let's spend more on people, when actually the only thing that's really going to help with productivity in the NHS is investing more in tech

Authors

Murray Ellender

Founder and Chief Executive, eConsult

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