Operose Health, United Kingdom
Updated May 7, 2020
Q & A with Dr. Nick Harding, Chief Medical Officer at Operose Health
Centene's Operose Health is an organization of general practitioner practices in the United Kingdom working to provide services to approximately 100,000 patients. Operose Health also delivers behavioral health and outpatient services, including ophthalmology and dermatology, to the National Health Service (NHS).
With the outbreak of COVID-19, which has infected more than 200,000 people in the U.K., the NHS required primary care practices to move their operations to remote work within a week, reserving in-person treatment for the most vulnerable and sickest patients.
Dr. Nick Harding is Operose Health's Chief Medical Officer and one of the people who led the organization's transition to video and telephonic consultations. Harding is a practicing clinician with over 20 years of experience. In addition to his work for Operose Health, where he continues to see patients, he has held a variety of regional and national leadership roles focused on administering and improving healthcare in the U.K., particularly around care integration, i.e., addressing a patient's health holistically and thinking about the wider determinants of health.
Q: What are the top things that are getting your attention on a day-to-day basis?
A: So the thing that I'm next worried about is the fact that whilst everyone is concentrating on the coronavirus, which is really important, how are we making sure that people with other conditions are being seen adequately? The second thing is the possible second wave of coronavirus and then the mental health effects of all of these things put together. How are we getting ready to deal with that in the future?
Q: How are you trying to encourage people to continue to look after their other health conditions but who are afraid to come in to be seen because of coronavirus?
A: Well, we are communicating to make sure that our patients know that we are open and available for care. We are calling our patients with chronic conditions. For example, for diabetic patients, we are calling them to say we've done your diabetic review. So the planned care, we making sure we're still delivering on it.
Q: What does your day-to-day look like now?
A: Ninety percent of all activity in healthcare happens in primary care in this country. Ten percent is in hospital-based care, etc. We transformed very, very quickly to be telephone-based to start with so that everyone gets some form of phone-based interaction, and then we moved straight on to being sure we could do video consultations. We've empowered video consultations in all of our surgeries now, installing software to make sure that can happen. In March, out of 30,000 appointments, 95 percent were done remotely.
Q: Do you worry about the patient-doctor relationship changing—going from a face-to-face model to telephone/video?
A: If you wanted an analogy, how many meetings have you now done by video conferencing that you would never have done previously, and has that changed the relationship? A bit maybe. Yes, it's a change, but change can also be positive.
We have a story of a lady in Nottingham who was suffering from mental health conditions, and as a consequence of that, didn't want to leave her house. Therefore, she had never really gone out to see her primary care practitioner because her fear of leaving the house was so strong.
Suddenly, when she can see her doctor on her smartphone, it changes her access to care, and once you change the access to care, you can develop a relationship, which we just couldn't have done before.
Now, if you already have a relationship, it's quite easy to continue it. Is it different? Yes, but it's just a new way of working that still allows for personal care.
Q: Once we develop a vaccine or treatment or are able to return to some level of normalcy across society because transmission slows, will these changes stay with the system?
A: That is the challenge. Now, I would argue that the first transformation that's happened that's really important is in the healthcare literacy of our population. Rather than being dependent on saying, "I know that I can go to my primary care physician to be seen." Now they're saying, "I know I can accept some phone or digital interaction first." One of the challenges for us is to make sure we keep doing that. That's part of our transformation journey anyway, but the changes spurred by the outbreak have allowed it to go faster.
I had a day where I was sitting here thinking, this little, small, round virus with spiky bits has caused more transformation of healthcare, than I've been able to do in 20 years. Because it's changed people's perception of healthcare, which has been very interesting and been part of the important future that we're trying to create together.
Q: Why is that important?
A: It's really important that people who are really sick can access healthcare easily. And you want people to access planned primary care for the types of interventions we want to do, and to be able to do that easily. We can help more people do that because we can now offer some of them [access] without them leaving their homes. Some can take breaks during the work days [for consultations] so that they don't have to take time off of work to be seen. We've normalized multiple access channels into primary care. And the whole of England now knows this, which is incredible.
One of the analogies that people say to me is that the banking industry went from people going to the bank to hand in their paychecks to one where trips to the physical bank are very rare. We need to change healthcare so that it does the same thing. Now, if you can access the primary care system without going? It makes [patients'] lives easier, and it makes our job easier, and it means they get better care.
Q: And you think that is better enabled through remote access to care than having someone go into a brick and mortar office?
A: I think you need both. To go back to my banking analogy, taking your paycheck to the bank used to be something you had to do every month. Now, your life's easier because you don't have to make that journey anymore, and the people in the bank are spending less time on that activity. Well, what are the activities going on in primary care in the U.K. that we can make happen more easily, more quickly for our patients, so that we can use the time of the clinicians more wisely?
Q: Is there a concern that some less tech-savvy patients may find this a new barrier to care?
A: We would have gotten pushback before this happened. Let's be clear.
All we're doing is saying, "Can you use something like Skype to see your doctor?" It's not the most technologically tricky thing. Most people aren't struggling with it.
Now, there still needs to be an option that people access their primary care through the phone or by walking in, but we just need to open up additional access channels.