Balloon debate: is technology the only way forward for primary care?

Professor Mike Kirby triumphed in a fascinating ‘balloon debate’ at I&A 2018 looking at the impact of technology in primary care. Six speakers presented their arguments for and against the motion before being ejected from the balloon by audience voting until only one was left!

The motion debated was: “This House believes that practice and patient engagement with technology is the only way for general practice to survive”

Before the debate began, 74% of the audience agreed that this statement was correct. But in the end, Mike Kirby’s well thought through arguments against the motion (and some blatant flattery!) won the day and highlighted the complexity of the issues.

Professor Ahmet Fuat, chairing the session, agreed with the winner and concluded that, “We must all embrace technology if we want to tackle current healthcare challenges. However, although robots and AI have an important role to play in complex surgical and diagnostic procedures, I feel they will never replace the therapeutic nature of the doctor-patient relationship in primary care. New technology also brings with it medico-legal issues that could be problematic. So, despite being very important, technology is not the only way for general practice to survive.”

 

For the motion

Sarah Jarvis (GP and media specialist), Chris Arden (GP and Editor-in-Chief of the PCCJ) and Professor Jamie Waterall (National Lead for CVD Prevention) presented a number of issues in favour of the motion. These included:

  • We are already living through a technological revolution – for example, 93% of adults in the UK have access to the internet.
  • Tackling long-term health inequalities and preventable cardiovascular diseases (with huge financial burden) require new ideas and technologies.
  • The need for primary care to use new technology adapt to survive and empower our patients. Increases in GP workload demands technological solutions.
  • The Internet provides some excellent evidence-based information and allows GPs to signpost patients to appropriate web-based resources to make informed decisions.
  • Tele-health offers huge opportunities for improved monitoring and communication, including patients who are elderly and being cared for at home, and infants who need careful monitoring for conditions such as type 1 diabetes. For example, Apple Watches and other devices can monitor for atrial fibrillation and other conditions.
  • The TECS case study database shows how telehealth projects have been implemented in the UK.
  • New devices are helping to manage drugs more effectively and to improve medicine adherence. They are helping in 24/7 monitoring of conditions (e.g. pacemakers).
  • New fitness monitoring Apps offer great potential for motivating and supporting patients to increase exercise levels.
  • There is a huge need for patient empowerment and new technology is helping to improve public health (e.g. 2.2 million completions of the heart age test online in one day)
  • The NHS has introduced numerous technological advances over its 70-year history and we need to keep embracing this approach.
  • Technology provides us with the opportunity to expand and evolve healthcare across boundaries that are currently unimaginable. Healthcare professionals need to be at the very heart of leading these advances in our vocation to improve the lives of those we serve.

 

Against the motion

Bev Bostock-Cox (Editor-in-Chief of the BJPCN), Alan Begg (Senior Lecturer, University of Dundee), and Prof Mike Kirby (Visiting Professor University of Hertfordshire) presented some strong arguments against the motion:

  • Technology is only part of the solution – the danger is that patient reliance on misleading information available on the internet could actually increase primary care’s workload.
  • Healthcare providers should be happy to embrace well tested and safe technology, but CQC reports show that many digital health providers are not providing safe care.
  • NHS has a poor track record in implementing digital technology (e.g. Babylon ‘GP at Hand’ App).
  • There are many other issues that should be tackled in addition to introducing new technology: the fundamental issue of GP overwork and low morale, part of which is due to new technology imposing itself into leisure time; the chronic underfunding of primary care (which receives only 7% of every £1 of NHS spending). In short, funding and workload management are more important issues than introducing new technology.
  • Increased technology (e.g. video consultations) may mean the closure of GP practices. Currently 37 private providers are registered with the CQC to provide online consultations.
  • New technology requires rigorous evaluation and regulation which is not necessarily being implemented at the moment. We must innovate but we have to evaluate!
  • Primary care requires a personal and face-to-face approach that new technology and online consultations cannot provide.
  • We need to guard against hacking, malware and viruses. Mobile devices are particularly vulnerable to being stolen or hacked if used on unsecured internet connections.
  • IT is expensive and increases the chances for invasion of patient privacy.