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The NHS - Time for Two Way Talk
Ever tried to get your GP's email?
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A communications revolution has swept through GP surgeries and hospitals over the last three years, though the technology involved is not exactly cutting edge. Suddenly, doctors have discovered the joy of text and if you are anything like me your phone is constantly pinging with messages reminding you about appointments or urging you to get a flu jab.
One company Accurx provides the platform which powers the vast majority of these automated texts, working with 98% of GP practices in England. A recent visit to its headquarters, near London’s Liverpool Street station and just across the road from Amazon’s main UK offices, illustrated for me how rapidly this form of communication - and with it Accurx - has grown.
“We went into Covid with about 30 people,” says the CEO Jacob Haddad. “And we are now about 230 people.” Showing me around the office the company moved into about a year ago - and which now looks pretty full - Jacob proudly points to the quotes from satisfied customers etched on a pillar.
“Accurx has changed the way we practice medicine,” says a London GP. “Simple technology and the use of SMS messaging has made a huge difference to accessibility for our patients.”
Another reads simply “If Accurx had feet, I’d kiss them.”
Now, the cynic in me wonders if there is another wall in some dusty corner of the building displaying negative quotes about the business, but giving GPs a simple, smarter way of communicating with patients does seem to have proved a surefire winner.
Jacob Haddad is convinced, unsurprisingly, that the answer to many of the current problems of the NHS lies in better communication - and he says the experience of delivering care during the pandemic showed GPs the way forward. He gives as an example a patient with a skin rash who before Covid would have got an appointment, shown the rash to the GP, and maybe walked out with a prescription. “Now if you call them up or go online and say I've got this rash, they'll say send us a photo. You send a photo, maybe they'll ask you some questions by messaging, then you get a prescription.”
He says the key thing here is that messaging is asynchronous - in other words a hard-pressed doctor and a busy patient don’t need to carve out a specific time to have a conversation - the patient can send an image on the way to work, the doctor can respond with a few questions later.
Before the pandemic, concerns about privacy and security made doctors cautious about exchanging documents or images with patients: “Before Covid when we said to a GP practice, you can send a document to a patient electronically. what came up was the risks - what happens if it goes to the wrong person, if the patient can’t access it.”
Then Covid happens, and people not getting their document, or coming into the surgery and exposing staff to infection are the bigger risks. “Now you try taking that away from people, patients or staff , and they’re not going to have it.”
Accurx’s simple messaging platform is also having some impact in hospitals where Jacob says it could help tackle one of their greatest problems, the huge and ever longer waiting lists for elective surgery:
“We're letting them contact the patients and say do you still need treatment. So you've got patients where their symptoms have gone away, or they haven't completely gone away, but they're not a problem now so they want a channel to get in touch when they need it, or they've had treatment elsewhere.”.
You would think that hospitals would be doing this anyway but as Jacob says telephoning or writing to 100,000 people is a huge job while texting them with a link to a short questionnaire is a lot simpler. Jacob says they can immediately cut waiting lists by 10% and, by following up with more detailed questions about symptoms, help hospitals prioritise more urgent cases.
But in one aspect of this communication revolution across the health service doctors remain cautious - they are keen to get messages to patients, not so eager to give patients a direct line to them. The Accurx platform gives GP practices flexibility when it comes to two-way messaging: “When they send a message they can choose - do they enable the patient to respond or not? “ says Jacob Haddad. “For 80% of messages it's not enabled.”
He says he sympathises with their reluctance: “There is, understandably a massive concern around the workload that comes with patients getting in touch.. They're really worried about what they call ‘opening the floodgates’.”
But he says those practices that do turn on two-way messaging know that if you deny the patient this opportunity to seek help they will try other routes:“If a patient can't respond but has a problem, it actually just creates more work for everyone.”
Anyone who has sat waiting on hold to an NHS helpline, then waited for a callback that never comes - as I did last week - will appreciate the value of having a direct line to a doctor or nurse.
You can see why health workers are the one group of professionals that are not always keen to communicate directly with the “customers” - ever tried getting an email address for your GP surgery? - but maybe it’s time that they learned that it is good to talk.