Innovating primary care

Dr Dan Bunstone
Clinical Director, Warrington Innovation Network

The opportunity for significant innovation in primary care is immense, yet we risk stifling progress by focusing too heavily on current challenges rather than future possibilities. We find ourselves in the ‘innovator’s dilemma’ – where disruptive innovation creates entirely new models, while sustaining innovation merely enhances existing models. This scenario is reminiscent of the Netflix versus Blockbuster scenario, where a revolutionary approach completely transformed an industry.

To truly revolutionise primary care, we must shift our perspective to a forward-thinking approach. This transformation involves empowering citizens, catalysing the delivery of primary care services, and realising the benefits of a system. We can create a revitalised primary care system that harnesses innovation and technology to empower patients, optimise health outcomes, and foster a thriving workforce dedicated to preventative and personalised care.

People-empowered health

The growing demand on primary care necessitates a shift from a purely clinical focus to a more holistic approach to health delivery. While social determinants play a significant role in overall health outcomes, we will concentrate on the potential impacts achievable within primary care. The core hypothesis is that a healthier population reduces demand, creating a virtuous cycle.

Empowering patients is at the heart of the transformation. Individuals are equipped with tools and knowledge to take true ownership of their health, going beyond mere control. This approach involves self-monitoring and data-driven action, supported by protocol or AI-based interactions for personalised advice. By reducing reliance on primary care services and enhancing personal accountability, patients become active participants in their health journey. For instance, if blood pressure is high, automated advice might suggest increasing physical activity, and aiming to lose 2kg, with a recommendation to recheck blood pressure in eight weeks. This low-touch approach can be applied to various health metrics, freeing up health services and improving individual health management.

Wearable technology plays a crucial role in the ten-year plan. These devices provide a rich stream of data that enables individuals to recognise signs of illness; track health improvements such as physical activity, sleep and nutrition; and make informed decisions based on real-time physiological metrics. This technology goes beyond simple step counters, incorporating clinically validated devices that offer real-time data. AI-supported systems can create bespoke treatment or lifestyle recommendations and trigger clinical escalation when necessary, opening new opportunities for illness prevention and care optimisation.

Annual clinical reviews complement the continuous data from wearables. These pre-bookable reviews support everyone and integrate wearable data. They feature near-patient testing with rapid results, contributing to a centralised ‘health metric’ visualisation. This comprehensive view provides clear, actionable next steps for clinically validated improvements. Through this approach, the focus gradually shifts from an illness service to a true health service.

The concept of citizen health scores, inspired by programmes like Vitality, further incentivises health-conscious behaviours. The system allows working-age adults to input data into the NHS App (or a proprietary app) and integrate information from wearables. By doing so, individuals can share in the financial benefits of improved health. Better health scores, reflecting reduced illness and economic costs, could lead to small but meaningful tax rebates. Additionally, healthy eating choices could be rewarded through supermarket loyalty card programmes, further encouraging positive lifestyle changes.

Primary care can evolve to empower individuals, leverage technology and create a more proactive, health-focused system. This transformation not only benefits individuals by improving their health outcomes, but also contributes to the broader economy by reducing healthcare costs and fostering a healthier, more productive population.

Catalysed health delivery

Reducing the number of people needing care is the first step in transforming healthcare delivery. The next stage involves efficiently supporting those with healthcare needs. Health delivery can be revolutionised through efficient booking mechanisms, streamlined consultations and automated administrative processes. We can enhance patient satisfaction while optimising healthcare resources.

Proactive care through data

Machine learning models will analyse anonymised patient data to predict health risks at both individual and community levels. This enables targeted preventive care, even before illness begins. GPs will have access to dashboards highlighting patients at high risk of developing specific conditions, allowing for timely interventions, and indeed predictive interventions to not only move left, but entirely shift left.

By integrating clinical data with information on social determinants of health, we can identify system and community-level health issues. The result is a more proactive and efficient healthcare system that addresses potential health issues before they become critical for the patient and costly for the system.

AI-based resource allocation

Full AI-based triage systems ensure patients are directed to the right clinicians at the right time, every time. This approach transforms demand planning into a data-driven process, making surges predictable and manageable. Healthcare teams will work differently, often in centralised hubs, and the often quoted 40 per cent of patients who don’t require primary care receiving support through alternative channels. The system will free up significant capacity overnight, addressing the recruitment crisis and reducing clinician burnout.

Patients will be able to book appointments tailored to their specific needs, with bespoke time allocations (such as ten minutes for a UTI vs 20 minutes for mental health concerns) without navigating through administrative barriers. The result is an ultra-low-friction system that benefits everyone, akin to the experience provided by companies like Amazon. The NHS App has the potential to play a crucial role in facilitating this streamlined process.

Ambient scribe

AI-powered ambient scribes will automatically transcribe and summarise consultations into a usable format, highlighting pertinent points and generating automated tasks, coding and referral letters. This technology significantly reduces administrative overhead while maintaining high-quality record-keeping. The result is more efficient consulting without compromising on the quality of patient records. The work life of all staff demonstrably improves.

Clinical decision support

At the point of care, AI will run searches through patient records to extract relevant information and results, providing real-time feedback to support high-quality decision-making. For certain conditions requiring minimal clinical intervention (such as tonsillitis with scoring criteria), the decision to prescribe can be largely automated. This approach ensures low-friction, efficient and safe healthcare delivery. Many of the large digital providers are already at this stage, with Google being a notable example. 

Unified patient records

A unified digital health record for every citizen, spanning all health and social care touchpoints, will address the complex needs of individuals and populations. This comprehensive approach allows for better stratification of populations based on need, enabling improved management and support throughout the health and wellness journey.

The lack of information visibility has been cited as a persistent obstacle across all parts of the healthcare system. By implementing a unified record system, the healthcare sector can catch up with other industries like retail, which have long since mastered information tracking. This unified system will eliminate the inefficient processing of referral and discharge letters, as patients will be fully managed at each care touchpoint. Interface issues will diminish and be addressed in real time, leading to a more seamless and efficient healthcare experience for all.

The healthcare system can evolve to become more efficient, proactive and patient-centred. This transformation not only improves the quality of care but also optimises resource utilisation.

The power of a system: a seamless continuum of care

The future of healthcare lies in the seamless integration of health and social care systems, creating a continuum where patients receive aligned support without clear demarcations between different parts of the system. This integrated approach focuses on enabling health, providing support during illness, and facilitating effective recovery. The goal is to create an environment where care is delivered holistically, regardless of which part of the system is providing it.

Nerve centres

At the heart of this integrated system are nerve centres, which provide a comprehensive view of resources across the entire healthcare ecosystem. These centres monitor hospital and community bed stock, primary and urgent care appointments, and ambulance positions and availability in real time. This approach mirrors the logistics systems used by multinational corporations like DHL, enabling a truly responsive healthcare system.

By analysing demand patterns, nerve centres can deploy teams to areas of greatest need, optimising resource allocation and improving patient outcomes. This system aims to remove the unnecessary complexity and ‘straw walls’ that currently create inefficiencies, consume time and lead to poor patient outcomes. The result is a streamlined, agile system that can respond rapidly to changing healthcare needs.

Data lakes and integrated information

The combination of health and social care data in comprehensive data lakes presents an unprecedented opportunity to impact people’s lives. By understanding the factors that contribute to illness and supporting the journey to health, we can extend not just lifespan but also health span (the period of life spent in good health). Data lakes will be structured to present information in a usable format for healthcare teams, with clear, definable outcomes. The integration of genomic data further catalyses the potential for personalised, effective interventions. This data-driven approach enables healthcare providers to tailor treatments and preventive measures to individual patients, maximising the impact of care.

Proactive interventions: shifting focus to prevention

Prevention becomes the cornerstone of the entire healthcare system in this integrated model. Recognising that preventive care is significantly more cost-effective than treating advanced illness, the system prioritises early interventions (for example, treating high blood pressure costs only pounds per patient, while managing cardiovascular events costs thousands.) In this proactive model, health and social care systems plan and work together seamlessly. The concept of ‘interfaces’ between different services disappears, replaced by a smooth flow through various care provisions. This approach ensures that patients receive the right care at the right time, often before serious health issues develop. Frictionless and effective.

The integration of these three elements – nerve centres, data lakes and proactive interventions – creates a healthcare system that is more efficient, effective and patient-centred. By breaking down silos between different aspects of care, this model enables:

1. Better resource allocation and use across the entire healthcare system.
2. More accurate prediction and prevention of health issues
3. Personalised care plans based on comprehensive health and social data.
4. Seamless transitions between different types of care as patient needs change.

This integrated approach represents a paradigm shift in healthcare delivery. It moves away from a reactive, fragmented model to a proactive, holistic system that considers all aspects of a person’s health and wellbeing. By focusing on prevention and early intervention, supported by real-time data and efficient resource management, this model has the potential to significantly improve health outcomes while optimising healthcare spending.

Conclusion

The future of primary care lies in creating a proactive, preventative and personalised healthcare system. By leveraging wearable technology, AI-driven analytics and integrated data systems, we can shift from a reactive illness service to a true health service that anticipates and prevents health issues before they arise.

This vision not only addresses the growing demand on primary care but also creates a virtuous cycle of improved health outcomes and reduced healthcare costs. By empowering patients with tools and knowledge, streamlining healthcare delivery processes and fostering collaboration between health and social care systems, we can create a more efficient, effective and patient-centred healthcare ecosystem.

The implementation will require a paradigm shift in how we approach healthcare, moving away from the traditional clinician-centric model to one that truly puts the patient at the centre of their own health. It will demand investment in technology, changes in policy, and a cultural shift in how both healthcare providers and patients engage with health management.

This approach to primary care has the potential to not only improve individual health outcomes but also to create a healthier, more resilient population. By embracing innovation and technology while maintaining a focus on human-centred care, we can build a primary care system that is fit for the future, capable of meeting the evolving health needs of our society, and extending not just our lifespan, but also our health span.