General Practice after COVD-19 – what’s the game plan?

We live in uncertain times. Almost everything in our lives has been affected by the COVID-19 pandemic. Scale and pace have been breathtaking. I’m uncertain where general practice will end up after the COVID-19 pandemic, but I’m pretty sure that it won’t go back to where it was. Perhaps it’s time to redefine general practice. A clear understanding of this would enable our digital future to be led by strategic aims, rather than mere availability of tech.

Game theory principles can be applied to general practice, I’ll pose questions around the services provided. Game theory is a mathematical theoretical framework which helps to predict behaviour, in which one anticipates another ‘player’s’ likely moves and helps to result in improved outcomes. It stems from economics and has applications in commerce, auctions and politics. It’s rarely been used in healthcare. 

Consider patients and doctors as players and you may assume that they’re co-operating – but in fact they often have competing agendas. 

There is inherent conflict built into the system. Patients want quick, holistic, personalised care. However, clincians are overwhelmed, resulting in delays, work in silos (even within teams) and delivery of care in disease ‘buckets’, eg diabetes. In short, patients often play a long-term or infinite game and clinicians resort to playing a short-term, finite game. The importance of prevention - the infinite game, is well documented, but difficult when providers struggle to cope with current demand and is hard to measure. 

Technology is increasingly used in healthcare to support both clinical care and administration. It can help bridge the gap between patients’ competing agendas and support prevention at scale. However, adoption has been slower than hoped, both from patients and clinicians, and there has been paucity of evidence of its impact. 

So what’s happening now? Well, the adoption issue has evaporated. In a few weeks, general practice has completely transformed the way services are delivered, with rapid mobilisaition for remote working. Our patient demand has fallen whilst capacity is beginning to stabilise. There has never been a more important time for general practice to work proactively, which is probably best done using technology as it needs to be delivered quickly and at scale. Our practice is testing groups of clinicians supporting groups of patients online using Zoom, Microsoft Teams and Youtube, complimented with online messages, triage and video consultations. Our survey of some 2,000 patients shared how they would like for us to communicate with them and we are working flat out to deliver this.

Patient Survey video

Currently, a plethora of IT providers are willing to offer their software for free. However, there’s a risk practices, facing uncertainty, will quickly deploy disparate software, resulting in fragmentation of current services, stressed staff during deployment and a mountain of work post pandemic to untangle.

Many frameworks could be applied for the COVID-19 pandemic. One of my favourites is outlined by Professor Markides, strategy professor at London Business School, in his book ‘Game-Changing Strategies’. He shares that innovation is not improving what we currently do but re-thinking the entire system. The WHO, WHAT, HOW model, outlined below, might help. It’s probably worth thinking about what it is we really do. Are airlines selling flights or destinations and memories? In the same way, is general practice all about the ‘GP appointment’ or should we support the relationship before and after the appointment? Is the focus on healthcare based solely on illness or should it move to wellness? 

WHO - Which patients?

Traditionally, we group patients according to a disease model such as diabetes, but perhaps behaviour segmentation ought to be considered - for example by using the Patient Activation Measure (PAM), which quantifies patients’ knowledge skills and confidence in managing their health and provides them with personalised support? Our practice developed fictional characters around CQC population groups so we could understand patients better and personalise the service provided. 

WHAT - Redefine what is being offered to patients. 

Explore patient ‘pain points’, (excuse the pun!). What is it that frustrates patients? What adds value? If access is important to patients and given the ability to work remotely, can we offer increased access in the evenings and at weekends? 

HOW - to play that game. 

How do we deliver care? We can then choose technology that best fits our priorities. The best place to start is to build on competencies within our practices. 

Understanding game theory models in general practice helps to mathematically calculate which areas of technology might bridge the gap between competing drivers for patients and clinicians and result in better outcomes for all. Technology is only one aspect however, unless we change the culture, incentives, structures and processes as well as support staff, nothing will change.

General practice must be made future proof, we need to own problems and solutions and innovate, now is the time. Game on!

Reference - Best Practice newsletter