How coronavirus could fast-track the NHS asthma digital health agenda

Brigitte West, Jarrad King, Dr Minal Bakhai and Pritesh Mistry on the positive foundations the outbreak could be laying for the future of primary care

Primary care is rapidly undergoing monumental change in response to the COVID-19 pandemic, and healthcare staff are responding to this immense pressure and working hard to rise to this unprecedented challenge.

The collaborative endeavours of the primary care workforce are essential in maintaining the strength and sustainability of our system. A key principle in delivering the national strategic response is for all patients to be remotely triaged to assess whether a face-to-face appointment is clinically necessary or whether follow up care and advice can be provided using a remote consultation. A digital-first approach is essential in protecting patients and staff from avoidable exposure to infection, facilitating rapid access to advice and information and supporting system stability by enabling remote working.

Health Secretary Matt Hancock announced in parliament early last week that the NHS will be rolling out a digital-first first approach across the country(1). This includes the use of triage and remote consulting platforms to assess individual needs online, via the telephone or video, prioritising the use of remote consultations wherever possible to mitigate the spread of infection. Resources were already being directed towards practices and Primary Care Networks to help them offer more digital services. Now, efforts are being super-charged.

In the week following the WHO’s announcement of a pandemic, Asthma UK has seen an unprecedented number of calls to our helplines (six-fold increase compared to same period in the previous month), WhatsApp service (nine-fold increase) and visits to our health advice pages (c. two million page views – and counting – on our coronavirus advice page alone) demonstrating an urgent need for fast access to personalised and evidence-based advice for the 5.4 million people with asthma on how to self-manage and what to do if their asthma deteriorates.

Digital primary care – where are we now?

The NHS has been on a clearly projected digital journey over the past 12-18 months. This is illustrated by the establishment of NHSX(2) and the commitments made within the NHS Long-Term Plan(3). These lay out ambitions such as patients having the right to a digital-first offer when accessing primary care by March 2024, alongside GP contract commitments for all patients to have access to online consultation and video consultations by April 2020 and 2021 respectively.

All this activity has been significantly accelerated in response to COVID-19, creating the infrastructure for technology to be effectively integrated into care pathways.

Across several geographies NHS Digital First Accelerators(4) have been pioneering work on redesigning care pathways using digital tools to provide an improved experience for patients, supporting patients to access the right services for their needs easily and optimise efficiencies to enable clinicians to spend more time with patients.

We have learned that when implemented well, digital technology can improve services for both digital users and non-users. We now have a real opportunity to use the accumulated data about care activities, resources and outcomes to improve services, to identify unwarranted variations and ensure equality for all people with asthma.

Over the last few months, we have been working on what a digitally-enabled care pathway would look like for people with asthma.

The long-term vision of digital-first services in asthma

The better utilisation of data and incorporation of new technologies (such as connected inhaler devices and diagnostic tools) into primary care could significantly improve asthma management, education and transform asthma outcomes.

We need to shift to a proactive approach, where patient data is used to monitor and predict when someone is at risk of an asthma attack or is required to make changes to their asthma treatment. To make this a reality, improved data sharing between healthcare services, shared decision making with patients and the incorporation of technologies into NHS care pathways is vital.

Prior to COVID-19, we developed this digital-first primary care pathway in collaboration with leading respiratory clinicians, policy makers and researchers.

We hope that current momentum and the newly emerging infrastructure can continue to drive the transformation of asthma management within primary care in both the shorter and longer term, making our digitally-enabled high quality care vision a reality. To do so, we need to make sure that people with asthma and their needs are considered in the current rapid scaling up of digital solutions in the NHS and the future development of technology and tech-enabled pathways.

We urgently need more effective, user-centred solutions for people with asthma. The development of digital technologies for people with asthma is still in its infancy and there is a common failure to recognise diversity in the asthma population and establish the varying needs of different sub-groups. We are keen to support digital health innovators to create high impact solutions for people with asthma and reduce health inequalities recently highlighted in Health Equity in England: The Marmot Review 10 Years On(5).

We actively support the drive towards more digital services across the NHS, but need to remember that these solutions must be implemented appropriately. While it’s paramount that these services are in place efficiently to protect health professionals and the public from COVID-19, we’re laying the foundations for the ongoing success of such services for years to come.

Please get in touch if you’re working on an asthma digital health product and can help us make this vision a reality – asthmalab@asthma.org.uk.

Authors:

Brigitte West – Innovation Lead, Asthma UK & British Lung Foundation Partnership
Jarrad King – Senior Policy Officer, Asthma UK & British Lung Foundation Partnership
Dr Minal Bakhai – Deputy Director and National Clinical Lead Digital First Primary Care, General Practitioner, NHS England and Improvement
Pritesh Mistry – Healthcare Innovation Expert, @mustbemistry

References:

[1] Online – available here.
[2] Online  – available here.
[3] Online – available here.
[4] Online – available here.
[5] Online – available here