The UK Government is currently in the process of attempting to radically transform healthcare in the UK. Over the course of the next 2 to 3 years, the top-down NHS model will be replaced by a bottom-up, GP-led commissioning model. In this new model much of the NHS’s current funding will be given over to, and managed directly by GP-led consortia.
A key reason for the desired change is that GPs are best placed to manage and focus budgets in-line with the requirements of the local community. As a result, centralised management costs are expected to be significantly reduced and patients will enjoy better outcomes.
This process has already started with the establishment of a number of path-finding consortia who will, during the early stage of this process, start to deliver healthcare based on this new model. These pathfinders will enable early visibility of any issues arising and highlight the benefits of the new model.
The context for telehealth
In this context, budgets could be used to purchase telehealth and other related technology such as mobile healthcare (mHealth). Whether or not this will happen to a greater degree than is currently the case depends on a number of things including:
· the level of awareness that GP commissioners have of these services
· their level of believe in these technologies to add value and reduce costs
· the availability of the required skill sets in terms of assessing patients suitability for telehealth, recommending equipment and training patients to use the equipment
· their ability to provide on-going support for telehealth services that they recommend
There is no doubt that telehealth will be used more and more, driven partly by patients such as the article’s author who know what is available, understand the benefits and request these services and also by GP consortia that have already had exposure to telehealth through research or pilot programs and believe that there are significant benefits.
Embracing telehealth will still be challenging
But over the next couple of years, GP commissioners will have enough work to do as they change their working practices to be aligned with the new funding model. Finding the time to investigate new technology will be challenging. Even in the most positive scenario where commissioners do embrace telehealth in a major way, a national roll-out is unlikely. GP-led commissioning is intended to be bottom up not top down so it will be up to locally led consortia to determine whether telehealth is relevant to the core services that they provide. This could change if telehealth is accorded “specialist service” status in which case it will still be the responsibility of centralised NHS commissioning board.
Should commissioners wish to investigate the telehealth solutions available, within the existing NHS structure there are tools in place that can help them. One of these is the Assistive technology framework agreements that are in place. Managed by the Government procurement agency, these cover a large number of telecare and telehealth suppliers providing a potential focal point for commissioners keen to see what commercially available solutions are available and obtain a view of the costs involved.
Still waiting for evidence
Currently, evidence from the numerous pilots and trials that have taken place over the last few years places the burden of proof back with technology providers. As recently as August 2010, a paper entitled, “sustaining innovation in telehealth and telecare”, published by the UK’s Whole System Demonstrator Action Network indicated that “there is still a lack of robust evidence for the cost-effectiveness of telecare and telehealth”.
Faced with this conclusion, the wider adoption of telehealth could be some way off but whilst this particular debate continues there is a bottom-up opportunity to ensure that newly and recently qualified healthcare professionals are formally introduced to the relevant technology and concepts. This should take place whilst in the final stages of formal training and through continuous professional development. Only in that way will a deeper understanding of the technology and associated telehealth skillsets be developed in a systematic way so that eventually telehealth becomes part of a core service rather than an “add-on”.
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