Who will take the Digital First throne?

By - Primary Care Journal

Who will take the Digital First throne?

Conor Burke, Director of CPB Consulting, explores how a new competitive digital market is emerging.

Last year, the NHS Long Term Plan set out a vision to offer digital first primary care to all patients in England within ten years. This includes new digital GP providers allowing patients the choice to register with them directly.

The ambition is to provide straightforward access to primary care services, eliminate variation in the pathway of care and help patients manage their own health better. This can potentially help address workforce shortages, particularly in deprived communities and where there are not enough doctors. It is here where clinicians will have more time to focus on those with the greatest need.

In June 2019, NHS England and NHS Improvement (NHSE/I) undertook a public consultation on developing digital first primary care. One of the things the consultation included was the reform of patient registration funding and contracting rules. These rules are aimed to help ensure patients have both choice and access to integrated care.

In September 2019, NHSE/I published its response:

  • NHSE/I intend to take forward the proposal for clinical commissioning groups (CCGs) to disaggregate a practice list and award a new Alternative Primary Medical Services (APMS) contract when a digital first practice registers more than 1,000 patients from another CCG.
  • NHSE/I intend to create new opportunities in around 20-25 per cent of CCG areas that lack GP capacity and/or have poor patient access.
  • NHSE/I will develop a national assessment process and criteria with commissioners and providers to create a new national digital first provider list in 2020/21.

The consultation also found that there was support for a “partnership approach” to forming digital first GP models. The response stated: “We (NHSE/I) expect the approved providers list could include a range of partnership models. This might initially include partnerships between NHS trusts or foundation trusts, whether acute or community, and digital providers. It could also include groups of GPs who want to set up their own new independent partnerships on a digital first model. We expect this route will provide a useful opportunity for people wishing to innovate in primary care. ”

The emerging market

We have started to see innovative partnerships between GP practices, NHS providers and technology suppliers emerge. They are positioning themselves in what is a new and increasingly competitive marketplace.

In August 2019 LIVI announced a collaboration with Our Health GP Partnership in Birmingham and Shropshire, building on their existing partnership in North-West Surrey to bring digital GP access to over 1.85 million NHS patients.

In November 2019, a GP surgery in Newham, east London, partnered with Docly to provide an online consultation service to avoid closing its practice after most of clinical staff went on maternity leave at the same time.

In January 2020, Babylon Health and the Royal Wolverhampton NHS Trust announced a ten-year partnership to develop a new model of digital first integrated healthcare, with services set to launch before the end of the year.

It is is still early days, and many variations may emerge across this market. But it looks possible that NHS trusts and/or large nationwide primary care companies, such as Virgin Care and Totally Health, could partner with new digital suppliers as disruptors and compete with incumbent GP practices in the 20-25 per cent of CCG areas forming the initial digital first market.

What will it mean?

How the market develops will very much depend on how attractive the new digital first specification is and what associated investment is like for new entrants. How NHSE/I and local commissioners use the provider list to develop a market and encourage competition will also be a factor. However, assuming this happens, both digital providers and GP practices will need clear strategies on how to respond to the emerging market.

Digtal providers will need to give careful consideration when choosing their partner. They might partner with existing GP practices, primary care networks (PCNs) and federations or they might collaborate with the larger NHS providers. It may be technically possible to partner and compete in both market segments, albeit in different CCG areas, although this could potentially create tension between a supplier’s core value proposition and how it is authentically positioned.

Digital providers will need to decide whether to position their offer as a tool to help existing GP practices deliver improved staff satisfaction and patient experience, thereby retaining their loyalty. Or they might choose to partner with new entrants, helping them grow their business quickly through registering patients from local GP practices. A full market analysis including payer priorities, challenges and local drivers will be critical to the successful implementation of a supplier’s strategy.

The new market will be driven by patient choice and it is important that existing GP practices are not complacent about the impact of this. They will need to consider carefully how to prevent the new entrants from cherry-picking their patients with exciting offers. Practices will need a robust approach to how they plan to compete with larger and arguably more commercially mature organisations.

GPs have everything to lose here. They will firstly need to ensure they have a comprehensive understanding of the service their patients desire and then they must create the right offers to retain patient loyalty. Digital channels will be required, but the GPs must also deliver a personal service and ensure continuity of care.

They must also consider how they might compete at scale. It might be that they form, or further develop, digital first federated arrangements with other practices and PCNs.

GP practices should develop a strategy for effective partnerships with digital providers. Only by doing so can they identify and leverage their combined capabilities and focus them on areas where they can best serve patients and consumers. They must also identify unmet needs and discover new and innovative ways of addressing them. Together, these things will create additional value.

The first step is for practices to identify the digital providers with which they believe they can work best, and then closely align their values and ambitions. Then, in collaboration, the GPs, practices and providers will need to determine if they have the right leadership, systems, processes, staff competencies and culture to become the most effective partnership of choice.

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