Amir showed me how patients access their own health records and gain a better understanding of their health care needs. Access and understanding are enabled by the use of apps that provide full online access to the GP electronic health record alongside the practice-based web portal. Patients are also able to book appointments, order repeat prescriptions and send two-way secure messages online.
Two-thirds of the 12,500 people registered with the practice have signed up (after an individual consenting process) for the online service and all the patients I met were aware of the service and were using it. This is a much higher coverage than in the rest of general practice, where the most recent GP patient survey shows awareness of online services offered by GP practices is still relatively low with use of these services considerably lower. The last survey showed only 3.3 per cent of respondents were accessing their medical records online.
Access to records and understanding are the foundations on which Amir, his partners and other colleagues have sought to build a partnership of trust with patients and staff. They are doing so in a practice that was formerly run by Harold Shipman, who achieved notoriety when he was convicted of murdering some of his patients between the 1970s and the 1990s. The commitment to responsible sharing and partnership has helped restore confidence in the care that is provided, and the practice was recently rated outstanding by the Care Quality Commission.
I saw how this works by sitting in on Amir’s morning clinic with his patients. The philosophy I observed was of patients being enabled to take more control of their health and wellbeing, for example, by checking test results, identifying and flagging any errors or omissions, and tracking trends in their care. Later in the day, I tested my observations in a roundtable discussion chaired by Ingrid Brindle who leads the practice’s patient participation group.
One of the benefits for patients is that they can share their records when they come into contact with other services and with family and carers. The latter is valuable for patients who are not confident in using online access themselves. There are particular benefits for patients with long-term conditions who are able to monitor their conditions and use information on their records to adjust their choices.
Reflecting on what I saw and heard, I was reminded of a phrase I heard many years ago on a visit to Kaiser Permanente in California, US. One of its medical leaders, David Sobell, told me that the most important primary care providers are patients themselves; the decisions patients take every day have a bigger impact on their health and care than those made by GPs, nurses and other clinicians. Systems like Kaiser Permanente had been slow to recognise this and Sobell was leading work to promote greater self-care by patients.
The NHS has also been slow to turn the rhetoric of patient engagement and patient empowerment into practice. The experience of Amir Hannan, Ingrid Brindle and their colleagues shows that progress is possible where there is a sustained commitment to develop a partnership of trust with patients. To be sure, the Haughton Thornley Medical Centres have more to do to get all clinicians, patients and the wider health and social care system involved, but their work demonstrates what can be achieved even within the limitations of existing systems and workload pressures.
What I saw was an example of the kind of NHS we need in the future, based on different relationships between patients and clinicians. These relationships have to be seen as meetings of equals in which the expertise of patients is at least as important as the expertise of clinicians and managers. They must acknowledge the responsibilities of patients as well as their rights and the vital contribution of patients in using information and understanding to improve their own health and wellbeing.
Technology can support this transformation, but fundamentally it is about a new deal with the public appropriate for the 21st century. As Derek Wanless warned in 2002, the public must be fully engaged in their care, otherwise the NHS will become unsustainable. The accumulation of many more locally led innovations, such as the one I observed, offers one promising way of heeding his warning and putting patients at the heart of care. I was left puzzled as to why all practices aren’t yet working in this way.
