New delivery models in a 21st century NHS

What does ‘free at the point of delivery’ mean for a 21^st Century UK health service?

I recently attended a conference at which two clinicians – one a GP, the other a Consultant – jointly presented their experience of how joined-up patient records are transforming healthcare delivery in the UK. I found it an inspiring session. Talking explicitly about a vision for ‘patient-centric care’, the two doctors explained how technology was changing both their and, more importantly, their patients’ lives. Here are just two quick examples:

·         By using a digital camera to photograph a lesion on a diabetic patient’s foot, the GP was able to then share the record with a diabetic consultant at the hospital, get their expert opinion and agree treatment. All without the need for the patient to wait for an outpatient appointment and then attend a clinic. And this was achieved in a matter of days, rather than weeks.

·         By using a set-top web-cam, the Consultant was able to have a virtual consultation with a patient who found it extremely difficult to travel. Even though the person concerned was elderly, he found this approach suited his needs perfectly and was happy with the treatment. And his GP was immediately updated on the treatment provided through the shared electronic patient records.

This got me thinking – if it’s possible to move to ‘virtual’ consultations for at least some conditions, coupled with a widening use of alternative service providers (for example private healthcare staff, rather than only those employed by the NHS) – what might this mean for the shape of the NHS itself? It could for example mean:

·         ‘Outsourced’ services for the majority of treatment of some conditions

·         ‘Off-shored’ services – perhaps going beyond interpretation of things like MRI scans (which already happens in some cases), but virtual consultations with doctors based abroad

·         ‘Self’-diagnosis through smart technology for certain simpler conditions.

Provided the services are capable of being provided remotely – or perhaps if patients choose to receive treatment in that way - AND the principle of ‘free at the point of delivery’ is preserved – does it matter that (possibly the majority of) services are provided by non-NHS staff? And interestingly – the quid pro quo might be that the ‘point of delivery’ moves to somewhere more convenient for the patient. For example, their own home.