Why the NHS should have Bloomberg Terminals

First comes the relief of finally getting a GP appointment. But second comes the mysterious, and frustrating, purgatory of a referral to hospital. While the patient’s health issue may have had some professional scrutiny it may not be enough to confirm a diagnosis. And so we arrive in the murky grey world between GPs and hospitals.?

This is an enduring issue in the NHS: the communication channels in place between relevant specialists and general practice are woefully inadequate, and in many cases non-existent. This leaves GPs cautiously referring-by-default, patients confused, and hospital clinicians frustrated.??

If a GP needs to chase up a secondary care referral, they have to send a letter. If a hospital doctor needs to speak to a GP, they have to phone up the landline everyone else uses. If a hospital doctor needs to book in an X-ray, they have to phone up the radiologist on shift.?

This communication vacuum is frustrating for everyone involved. From the patient’s perspective, they may have a troubling health concern and have no way to follow up who the referral has been sent to, which hospital the doctor is based in, if it’s been accepted and when an appointment might be available.??

From the GP’s perspective, there is a struggle to contact specialist doctors over the phone which has proven problematic when they can’t tell whether a patient needs to be referred and/or the urgency of the referral. GP surgeries also manage a large volume of waiting list enquiries and spend significant time writing ‘expedite letters’ to encourage secondary care colleagues to see the patient sooner. All the while, secondary care clinicians say they receive too many inappropriate referrals which could be more effectively managed in general practice. This can then lead to an excessive burden on the secondary care specialist system.?

Lessons may be learned from the private sector. There are not many instances where I would recommend imitation of investment banking in the health system but there is one permanent feature of the trading world that the NHS should take note of: the Bloomberg Terminal.??

The Bloomberg Terminal is part of the furniture in investment banks, private equity, hedge funds, pension funds, and more. Provided by the market information company Bloomberg, literally every organisation that engages in professional capital markets trading will have a Bloomberg Terminal for every trader and salesperson.??

Bloomberg Terminals provide many different services and have existed since 1982. Primarily, they provide real time market data. Crucially, they also have a messaging platform across a secure network used as the main form of communication between different organisations. This enables a trader in, for example, Morgan Stanley to speak to their client at Macquarie to ask if they want to execute a trade at a specific price at that time. ?

The business model of trading requires the ability to talk to other organisations — their clients — very quickly before a price changes, as well as with other trading desks within the same company. In essence, Bloomberg Terminals enable traders and brokers to tap into the entire global capital markets ecosystem very easily. ?

The same conditions are true for referrals in our health care system. Both trading and health care are time sensitive and affect the stakeholders (patients in this case) substantially if not dealt with effectively. Both deal with highly sensitive information for each of the organisations. Both require decision making from different people in different locations at the same time. And yet, there is no equivalent of the Bloomberg terminal for different parts of the NHS. If there was ever going to be an advantage to having a monolithic NHS it would be to have consistent technology infrastructure across the system.?

Too often discussion on technological change in public services is oriented around the most sophisticated technology possible. More AI, more data driven insights, more LLMs. But perhaps the architects of the NHS Ten Year Plan should be looking to market infrastructure from 1982 to help solve one of the most basic frustrations in the health system. ?