Last week’s furore over a lack of funding for GPs is part of a familiar trend that has seen in particular the Royal College of General Practitioners in Scotland at loggerheads with the government over funding.
This makes for banner headlines and highlights the obvious problems in the relationship between the Scottish Government and general practice.
However, contained in the RCGP consultation paper on technology and innovation in the NHS were a number of key issues around the use of GP online services.
A report by the think tank Reform Scotland found that GP surgeries are set to miss a 90 per cent target set for online repeat prescription and appointment bookings.
NHS Highland in particular has borne the brunt of criticism with only 25 per cent of GP practices in the area offering online appointment booking and repeat prescriptions.
The RCGP say that the problem of poor connectivity, both in terms of access to high speed broadband and delivery of 3G/4G signals, has hampered the existing eHealth strategy and will continue to slow progress if not improved.
The issue of poor connectivity is not just limited to rural communities with doctors working in towns and cities also citing similar problems. The general consensus among frontline GPs is that the IT systems used in the NHS have failed to keep pace with the current technology being rolled out.
Although doctors recognise and embrace the opportunities presented by technology, there are real concerns that unless connectivity improves GPs in rural and remote areas will fail to see the benefits.
Doctors overwhelmingly would like to see the basics of technology improved across the country before any advanced model of e-technology or eHealth is introduced. In this respect the Scottish Government is putting the cart before the horse.
It was also noted by the RCGP that there has been a failure to move from the continued use of incompatible systems and various platforms used by the different agencies across the NHS. This means there are shortcomings in the sharing of key patient information between primary and secondary care teams.
Clinicians working in the out-of-hours period have limited access to complete patient records compared to that for ‘in hours’ colleagues, meaning they are in a difficult position when treating patients and must work without easy access to all the facts. Those living in areas of deprivation are more likely to use the out-of-hours service - therefore this lack of access is a diminution of the care that is available to them.
Poor levels of literacy, something highlighted recently by Scotland’s Chief Medical Officer Catherine Calderwood, also mean that doing something like sending your doctor an email for a repeat prescription is far beyond the ability of patients who struggle to follow basic dosage instructions.
So instead of benefiting the most vulnerable in society, there is a danger that increased technology will actually exacerbate existing health inequalities. The crucial one-to-one relationship between doctor and patient in a community setting is under threat if everything is done online.
The move towards innovations like eHealth and telecare is to be welcomed but it must be recognised that vulnerable people in areas of deprivation and elderly patients do not always have access to computers and in many cases an online booking system is nothing more than an elusive ideal.