What is driving the 'left shift' in medicine?

·           Over 300,000 have been waiting for over a year

·           Over 50,000 were waiting more than 65 weeks

·           More than 5,000 cases have been waiting for more than 78 weeks

·           58.3% of cases have been waiting up to 18 weeks – well below the 92% target

·           In April 2024, 1.7m new RTT pathways were started

·           Just 310,000 pathways were completed as a result of admitted treatment

·           1.17m were completed in other ways (non-admitted)

·           Digital triage

·           Remote consultation

·           Coordinated discharges

·           Admission avoidance techniques

·           Sharing of waiting lists

·           Rapid technology deployment

·           Patient-initiated follow-up

·           Digital advice and guidance

·           ‘Call before you walk’ scheme

·         Lower rates of serious conditions: Conditions like cancer, diabetes and others that can require acute care if not caught early could be tackled in a more effective manner if they spotted at primary care levels. Many of these could even be treated as outpatients, reducing the need for in patient care and beds.

·         Reduction of emergency admissions: NHS England reports^[4] areas with better access to primary care services have seen lower growth in emergency hospital admissions. This suggests that when primary care is accessible, patients are less likely to wait until their conditions worsen to seek help, reducing the strain on emergency services.

·         Less pressure on acute care: The reduction in emergency admissions and catching serious conditions earlier could lead to reduction in pressure on acute care units.

·         Reduction in waiting lists: This all would, in turn, reduce the waiting lists, freeing up doctors’ and specialists’ resources to spend more time with patients and treating those who are acute cases.

·         Beds freed up: Eventually, the beds would be freed up meaning those in need of beds could get one and stay in one for longer periods, allowing longer recovery times and reducing the risk of readmittance.

·         Easier access to local GPs and primary care: With investment and a more effective primary care service, it would mean people would have easier access to these services.

·         Higher engagement with healthcare services: Surveys and patient feedback indicate that ease of access to primary care, such as being able to book appointments conveniently, is linked with higher patient satisfaction and better engagement with healthcare services. This improved engagement leads to more timely medical interventions and better overall health.^[6]

·         Better management of conditions: Community pharmacies have been instrumental in flu vaccinations and managing conditions like asthma, which helps in early intervention and better health management overall​.^[7]

·         Rise in self-care: People with conditions that need management would be in a better position to manage that condition themselves – whether that’s better management of medicines or having a bigger say in when and where they receive treatment. ^[8]

·         More likely to catch serious illness and receive treatment earlier: For more serious conditions, these could be caught earlier with higher engagement with primary care.

·         Reduction in health disparities: The Health Foundation^[9] notes that certain demographic groups, including those from socioeconomically deprived areas, report worse access to primary care and subsequently poorer health outcomes. Ensuring better access to GPs and other primary care services is vital for addressing these health disparities​.

·         Delivery plan for primary care access: The NHS launched a plan in 2023 to “tackle the 8am rush”, referring to the number of people calling GPs at that assigned time to try and get an appointment. This is key to shifting treatment to primary care – getting access. The three main tactics here include empowering patients through tools, ‘Modern GP Access’, and building capacity within primary care providers.

·         Training for care navigators: Part of the plan is aimed at providing better training for GP staff to guide patients to the most appropriate care to help reduce unnecessary GP appointments. For example, it would empower GP staff to suggest self-care where they feel it’s suitable to prevent a GP appointment. Around 6,000 GP staff have registered for the training so far.

·         Expanding self-referral services: From September 2023, the NHS expanded self-referral services for conditions like musculoskeletal issues and podiatry. This would, in theory, allow around 30,000 people to access their required care directly each month​.

·         Boosting pharmacy services: Pharmacies are to be used like a triage service through a ‘Pharmacy First’ approach. Services such as blood pressure monitoring and oral contraceptive prescriptions are now available at pharmacies, removing the need to visit GPs. This, along with other tactics, could reduce GP appointments by 10 million a year.

·         Digital tools: While digital tools might not work for everyone, they are a vital tactic to move primary care from face-to-face to virtual. The NHS has introduced digital telephony and online consultation tools to both streamline appointment booking and improve patient access to services​.

·         Proactive care for certain demographics: Proactive care for people living at home with moderate to severe frailty has been prioritised. This tactic, which includes comprehensive assessments and personalised care plans, could help maintain independence and prevent hospital admission.

·         NHS Prevention Programme: This initiative aims to boost early detection - and hopefully prevention of - diseases such as diabetes, cardiovascular conditions, and cancer​. It is focussed on areas of deprivation, where such diseases are more common.

·         CIPHA (Combined Intelligence for Population Health Action): Graphnet's CIPHA system integrates analytics, shared care records, remote monitoring, and patient access tools to support proactive and preventative care. This system helps identify patients who need proactive support, allowing healthcare providers to create actionable, trackable care plans and manage these patients at home, reducing the need for hospital visits.

·         Data-driven decision making: Graphnet's platforms allow healthcare providers to analyse patient data on both an individual and demographic level to identify high-risk patient cohorts and implement targeted interventions. For example, in Slough, the use of population health data has helped identify residents in need of support, leading to tailored interventions such as mental health support and digital literacy programs​.

·         Remote monitoring and virtual wards: By implementing remote monitoring technologies, Graphnet supports continuous patient care at home, which helps in reducing hospital admissions and ensuring patients receive timely care. This approach has been successfully applied in care homes to improve outcomes for residents​.

·         Enhanced Shared Care Records: Graphnet’s shared care records allow seamless information sharing across different care providers, ensuring that all members of a patient’s care team have access to the necessary information. This improves coordination and efficiency in delivering proactive care​.

·         Supporting Health Inequalities Initiatives: Graphnet’s tools are used to address health inequalities by identifying and supporting vulnerable populations. Their data-driven approaches help in deploying resources effectively to areas and individuals most in need, such as those living in socio-economic deprivation.