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Dr Damian Williams

Dr Damian Williams

Dr Damian Williams

Dr Damian Williams

General Practitioner
Hall Green Health
I am a general practitioner in Birmingham with a special interest in Medical IT especially in the context of clinical commissioning. I am clinical lead for business intelligence for our CCG as well as clinical support for contracting for a large local hospital trust. I am medical director of Ask a GP (askagp.com) and trustee of Just Caring Midlands (www.justcaring.org.uk)
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Technology – The saviour of the NHS?

Does the NHS really need saving? Your first question may be ‘does the NHS really need saving?’, and I would have to answer with an emphatic ‘Yes’. April this year sees the official start of Clinical Commissioning Groups (CCGs), the key component of The Health and Social Care Act, one of the biggest changes the NHS has seen. Amongst other things these organisations are tasked with saving the NHS £20 billion in the next 3 years by means of ‘efficiency changes’, despite the Institute of Fiscal Studies saying that the NHS needs to be spending £20 billion more each year by 2020. A daunting task but even more so in the light of the recently published Francis Report, where failings at Stafford Hospital have highlighted the need for compassionate patient care to be at the centre of all decisions. All of this has to be achieved in the largest publically funded health service in the world, which employs 1.7 million staff and serves more than 62 million people, with an annual budget of £106 billion (2011/12). So is it the solution? Clearly technology cannot be the only solution to this problem but I believe technology is pivotal in achieving the ‘efficiency changes’ desired. This might be direct use of technology to improve efficiency or may indirectly provide the intelligence that can drive non-technology based efficiencies; and if technology can be used to save clinicians time this can be reinvested into improving patient care. The NHS already has or is working on a number of national scale IT projects that could bring efficiency savings such as choose and book, electronic prescription service and map of medicine to name but a few. Newer and more localised projects include telehealth, clinical decision tools, remote working, the use of social media and real time patient data analysis. Yet many of these ideas, though new to the NHS, have been employed in business for many years. The NHS needs to catch up and then to further innovate. We need clinicians, managers and IT developers to work together if we are to be successful. Such change is not without its challenges and the size and complexity of the NHS makes implementation of change difficult. Patient safety and confidentiality has to be paramount but these create practical and technical barriers to development. I have just completed Connecting for Health’s Clinical Safety Training and there are some formidable hurdles to development and implementation of new IT systems in the NHS (ISB0129 and ISB0160). Procurement in the NHS is a beast of its own that I wouldn’t claim to understand but the processes are complex potentially making it difficult for small developers. The necessity of financial savings means the best solutions are not always chosen, even though that can be false economy in the long run. Yet we must not let these barriers stop us from seeking to employ technology for the good of clinicians and patients. We must not let them stifle innovation or be frustrated by what can be a slow process at times. The NHS recognises some of these issues and is working to try to help small businesses negotiate these obstacles. I hope in a series of posts in coming months to look in more detail at some of the technologies currently being used in the NHS, as well as emerging projects, and the opportunities and problems that surround them. I may stray occasionally into statistics or politics if you can cope with that! I am a practicing clinician with fingers in many pies so the frequency of my postings is likely to be inversely proportional to the workload I face! Comments are always welcome but I may not always reply in a timely manner.  
Dr Damian Williams
over 7 years ago
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Technologically Challenged

I have just visited Meducation to be told that I am using an unsupported browser - the old and outdated Internet Explorer 7. Internet Explorer 7 is old and I wouldn't choose to use it BUT as a GP I use the NHS Choose and Book website and only IE is supported and until fairly recently only up to IE7. IE8 is now supported but as most GPs computers are a few years old they still have IE7 (some still have IE6). GPs have been strongly advised not to upgrade IE. My solution is to install Chrome but I have to make sure it is not set as the default browser otherwise Choose and Book will not work. Some GP computers are so locked down you wouldn't be able to install a new browser even if you wanted to. This is just one example of how NHS IT is lagging behind. It is equally frustrating that NHSmail email boxes are limited to 200Mb by default (I had to beg for an increase to 500Mb) and most GP surgeries have between 2Mbit and 8 Mbit broadband (the N3 network provided by BT). And don't even get me started on the almost complete lack of WiFi in the NHS! We talk about advances in IT but in many areas we are still playing catch up!!  
Dr Damian Williams
over 7 years ago
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Worst Medical Experience Ever

Worst experience ever? - this is pretty difficult as I've worked in some of the poorest countries in the world and seen some things that should never happen like children dying of dehydration and malaria. But this recent experience was definitely the worst. It was midnight and I was trying to get my 16 month old to sleep having woken up after vomiting in his cot. Despite paracetamol, ibuprofen, stripping to nappy, damp sponging and having the window open he went rigid and started fitting. It only lasted a minute or two yet felt like an eternity as he was unable to breathe and became progressively blue as my mind raced ahead to brain damage or some other horrible sequalae. The fitting stopped and my mind turned to whether I was going to have to start CPR. I lay him on the floor and put my ear to his chest and was glad to hear a strong heartbeat but he was floppy with a compromised airway so I quickly got him in the recovery position. The ambulance arrived in 8 minutes and after some oxygen and some observations he was strapped in and ready to go. He had been unconscious for about 15 minutes but was starting to come round, much to my relief. The ambulance crew were great and their quick response made all the difference but then they took nearly half an hour to get to A&E in the middle of the night because they took the most awkward route imaginable. I don't know if it was a deliberate delaying tactic or just a lack of local knowledge but even without a blue light I could have done it in half the time! Why do ambulances not have GPS - ideally with local traffic info built in? We arrived in A&E and were ushered to a miserable receptionist who took our details and told us to have a seat. I noticed above her head that the wait time was 3.5 hours, though we did see a junior nurse who took his observations again. Not long after the screen changed to a 5 hour wait and a bit later to a 6 hour wait! I am glad to say that by about 3 hours my little man was back to his usual self (as evidenced by his attempts at destroying the department) and so after getting the nurse to repeat his obs (all normal) we decided to take him home, knowing we had a few more hours to wait for the doctor, and that the doctor was now unlikely to do anything as he was now well. I tell the story in such detail in part for catharsis, in part to share my brief insight into being on the other side of the consultation, but also because it illustrated a number of system failures. It was a horrible experience but made a lot worse by those system failures. And I couldn't help but feel even more sorry for those around me who didn't have the medical experience that I had to contextualise it all. Sickness, in ourselves or our loved ones, is bad enough without the system making it worse. I had 3 hours of walking around the department with my son in my arms which gave me plenty of time to observe what was going on around me and consider whether it could be improved. I did of course not have access to all areas and so couldn't see what was happening behind the scenes so things may have been busier than I was aware of. Also it was only one evening so not necessarily representative. There were about 15 children in the department and for the 3 hours we were there only a handful of new patients that arrived so no obvious reason for the increasing delay. As I walked around it was clear to me that at least half of the children didn't need to be there. Some were fast asleep on the benches, arguably suggesting they didn't need emergency treatment. One lad had a minor head injury that just needed a clean and some advice. Whilst I didn't ask anyone what was wrong with people talk and so you hear what some of the problems were. Some were definately far more appropriate for general practice. So how could things have been improved and could technology have helped as well? One thing that struck me is that the 'triage' nurse would have been much better as a senior doctor. Not necessarily a consultant but certainly someone with the experience to make decisions. Had this been the case I think a good number could have been sent home very quickly, maybe with some basic treatment or maybe just with advice. Even if it was more complex it may have been that an urgent outpatient in a few days time would have been a much more satisfactory way of dealing with the problem. Even in our case where immediate discharge wouldn't have been appropriate a senior doctor could have made a quick assessment and said "let's observe him for a couple of hours and then repeat is obs - if he is well, the obs are normal and you are happy then you can go home". This would have made the world of difference to us. So where does the technology come in? I've already mentioned Sat Nav for the ambulance but there are a number of other points where technology could have played a part in improving patient experience. Starting with the ambulance if they had access to real time data on hospital A&E waiting times they may have been able to divert us to a hospital with a much shorter time. This is even more important for adult hospitals were the turnover of patients is much higher. Such information could help staff and patients make more informed decisions. The ambulance took us to hospital which was probably appropriate for us but not for everyone. Unfortunately many of the other services like GP out of hours are not always prepared to accept such patients and again the ambulance crews need to know where is available and what access and waiting times they have. Walk-in patients are often also totally inappropriate and an easy method of redirection would be beneficial for all concerned. But this requires change and may even require such radical ideas as paying for transport to take patients to alternative locations if they are more appropraite. The reasons patient's choose A&E when other services would be far more appropriate are many and complex. It can be about transport and convenience and past experiences and many other things. It is likely that at least some of it is that patients often struggle to get an appointment to see their own GP within a reasonable time frame or just that their impression is that it will be difficult to get an appointment so they don't even try. But imagine a system where the waiting times for appointments for all GPs and out of hours services were readily available to hospitals, ambulances, NHS direct etc. Even better imagine that authorised people could book appointments directly, even when the practice was closed. How many patients would be happy to avoid a long wait in A&E if they had the reassurance of a GP appointment the next day? And the technology already exists to do some of this and it wouldn't be that hard to adapt current technology to provide this functionality. Yet it still doesn't happen. I have my theories as to why but this is enough for one post. In case you were wondering my son appears to have made a full recovery with no obvious ongoing problems. I think I have recovered and then he makes the same breathing noises he made just before the fit and I am transported back to that fateful night. I think it will take time for the feelings to fade.  
Dr Damian Williams
over 7 years ago