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In this blog, NAPC’s Deputy CE Katrina Percy and digital programme members Sura Al-Qasaab and Joanna Fox outline the steps to the successful implementation of the ‘digital front door’ currently being rolled out in practices across Northwest London. They share what it takes to get it right, the realities of adoption and busting the myths. They also propose where we might be in 10 years’ time!

Every programme delivered by NAPC starts with asking what it means for patients, staff, and the delivery of healthcare more generally. The implementation of the ‘digital front door’ demonstrates the commitment to working collaboratively with staff, giving them a voice to ensure the barriers and the enablers are understood, and the programme resonates with the people who will continue to benefit from it long after NAPC colleagues have moved on. Though important to say there is no ‘cut off’ time for support.

So, what is a digital front door? It can be described as a digital platform or interface, a route of accessing care for patients in a streamlined way who may then be signposted onto other forms of care. It’s the first entry point into accessing care and information, the NHS app is a good example. It’s a simple route to access and care for patients who have traditionally had to make a trip or a call to the practice. The app has multiple functions both for practices enabling them to send reminders and messages to patients, and for patients who have a tool to book repeat prescriptions, refer to medical records (if previously arranged with the practice) and receive those important blood test results and reminders about appointments and vaccinations.

Joanna helpfully describes the digital front door as the initial entry point for patients, just as a physical front door is the route into a house, for example. A physical front door might have a number of uses – a post box for post, an area where the milkman can leave milk and a lock for people to unlock and enter the property, thus highlighting that the doorway can be used for a multitude of purposes and by many different people. So, it is the digital front door which will allow patients, staff and citizens to enter and access the services they require, putting the control into the hands of those entering.

Katrina makes the point that it could be said that in the past, the patient journey has been quite passive; therefore, this is supporting and encouraging the patient to change and will activate the individual and allow them to take control, rather than being passive and waiting for someone in the practice to send through their results. This shift of emphasis encourages the patient to be more proactive.

To encourage the adoption of health technology, we should encourage all members of staff within practices to challenge their cognitive bias on who they think may or may not be suitable to use technology; we should challenge and test our own assumptions rather than fall back on our own bias. Many people with long-term conditions have been using remote testing digital technology from the comfort of their living room and sending the results through to the practice. The key is to explore how much or how little patients want to use technology and respond accordingly.

Sura states that the pandemic accelerated digital access because of necessity, and many more of us were encouraged to adopt the technology much more readily, just as people have done with online banking, for example. The important thing now, Sura says, is making sure we continue to progress and do not revert. Some people are not always comfortable with a digital option, but it is our responsibility to make it so accessible and useful that it becomes the preferred option.

Katrina reminds us that if we are activated to take control of our own health needs, our health outcomes improve. If we give people the tools to get proactively involved, just doing that alone will benefit patients. Often when people are frustrated with the NHS, the frustration is often poor operational processes and lack of coordination across systems. If we really embrace this opportunity, we could allow technology to improve these things that frustrate people and, in doing so, create safer services, taking the complexity out and avoiding human error.

Adopting to new ways of working using technology needs careful planning and enough time devoted to support staff. Working with colleagues across Northwest London, Sura describes how they ensured clinical safety both for patients and staff by demonstrating how the technology supports both clinical and non-clinical staff to do a better job and provides safe services across 300 practices in 8 boroughs to a population of 2.8 million people with very diverse needs.   Exploring where additional checks and balances where needed to optimise even further was also essential. To do this, action learning sets were offered to staff and have been key in establishing peer support. It was an opportunity to share how the technology is used differently and is operationalised for and across these populations. There is inevitable differences between practices and it is evident that there is a need to understand wraparound clinical processes to support people, as there is always an element of human interaction with the technology and seeing it as an evolution- its not about just flicking a switch. Not all staff are automatically completely confident and one important factor is investing in staff development to get the most out of the tools. Jo added the importance of having a framework to underpin the programme that sits around the digital front door just as a physical door is held in place by a frame and hinges, so too the digital front door hinges on the workforce. Observations from within as to what is working well and needs to be challenged are important; it’s essential to consider the end users of any technology and to have those implementing it sit with the providers. The more technology is tested at the front line the more it will help drive better outcomes for patients. Not just staff experience and voice but patients input too.

Katrina observes that it’s about creating the headspace but also the need to roll up sleeves and work alongside people.  NAPC colleagues are always there to give that support and getting out and working with frontline teams is what we are passionate about.

Technology is moving at a very fast pace, so in 5-10 years, the digital front door will be the norm, with technology being much more interactive – it will be interesting to see to what extent AI and Chat GPT can feed information through to the patients without even having to go through the front door. A much smarter use of technology in health care and across the system with other anchor institutions is inevitable.

So, what does the future hold for the ‘digital front door’, what does success look like? When we don’t need a front door anymore, that’s when we know we have successfully implemented technology that will enable people to lead healthier lives and achieve healthier outcomes. That said, let’s not lose sight of the fact that healthcare is still all about humans and human interaction, working with people and creating headspace to deliver better outcomes for populations and the workforce that serves them.

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