Are digital prescriptions the future to tackle our NHS crisis?
In the UK we are facing a mental health crisis, long waiting list for operations and people struggling to access NHS services. Covid 19 has created a crisis in the NHS with stretched clinical workforce and long waiting lists for care. But there are digital and technology solutions that could be adopted to help deliver care and keep people healthy but often equal access to these solutions is a challenge.
Currently, if you go to your GP with feelings of anxiety and low mood it is likely they will prescribe anti-depressants and you’ll pay for this medicine through a standard NHS prescription cost. Let’s change that scenario, your GP knows about an evidence-based app that helps their patients to improve their mental health through clinically validated exercises, and advice and your GP prescribes you this ‘digi pill’ that is paid through the standard £9.35 prescription charge in the same way as your medicine.
For those facing the starkest health inequalities and a cost-of-living crisis, buying a healthcare app will not be at the top of their priorities. Imagine if someone who is eligible for free prescriptions could have the cost of the app paid for through the NHS prescription scheme, thereby levelling up healthcare for those that most need prevention of ill-health.
The traditional way of prescribing medication within the NHS requires the medical professional to issue a prescription and the patient goes to their local pharmacy to pay and pick it up. The challenge with prescribing apps is how to collect the payment without using local pharmacies, but the roll-out of the NHS app during the pandemic provides this opportunity. With 22 million people using the app, and many patients using pre-paid prescription certificates the mechanisms to prescribe ‘digi pills’ for all types of health conditions could be the golden bullet. Building on the success of the NHS app provides an opportunity to integrate healthcare apps with the patient’s electronic records.
Germany has already embraced this approach; since 2020 doctors can prescribe apps to patients through the DiGA directory for evidence-based and CE-marked low risk digital health apps that have undergone a 3-month fast track assessment. Those patients with statutory health insurance can benefit from apps to detect, monitor, treat, or ease disease including mental health, long-term conditions, and chronic conditions. Should the national UK policy makers address the barriers to adoption for many evidence-based health apps by changing the payment model?
One key concern if how do we know which apps are clinically safe and that the companies won’t sell our confidential data? NICE, the National Institute for Health and Care Excellence, provides evidence-based guidance for the health and care system and has reviewed positively a number of healthcare apps that are regulated and recommended within a patient’s care. Sleepio, an app that uses cognitive behaviour therapy to improve sleep, was found by NICE to be more effective that sleeping tables and methods which help treat people with insomnia. NICE experts reported that it could save the NHS money through reduction in sleeping tablets. But there is no way for every GP to easily prescribe Sleepio - some areas like Thames Valley do pay for Sleepio for their population but this is not the case in the majority of the English regions.
It takes considerable effort and many years to get NICE to approve and recommend digital and technology solutions, and it is not a simple process. Even with a positive NICE approval, health apps like Sleepio are not readily available or funded in a sustainable way. For some companies who want to sell into the NHS they face challenges such as fragmented services whose priorities are tackling the waiting list and workforce crisis. For NHS commissioners there is no easy way to fund these apps at scale; some may see the value for their area, but they are not systematically funded across the whole of the UK. For companies that develop these healthcare apps selling directly to consumers is an easier route, but this further widens the gap between those who can keep afford app subscriptions to help them keep healthy and prevent ill-health and those facing the starkest health inequalities. This doesn’t seem fair or address the levelling up agenda.
Most apps are affordable at approximately £5-£12 per year. If in the UK we had a system to prescribe apps safely and for patients to pay in the same way as medication (like antibiotics) these apps will not just be cost neutral but could make savings through avoiding treatment like physiotherapy, talking therapies or diabetic care.
Take musculoskeletal (MSK) conditions or injuries for example, which are the most common category of first diagnosis for A&E patients. What if we considered evidence-based apps like GetUBetter for those for people who have joint pain or lower back pain? This app provides self-management advice for their condition, physiotherapy exercises on videos, and can connect to them to their local NHS MSK service for a referral. GetUBetter is available to the south west London population and specifically for patients treated at St George’s Hospital’s A&E unit in Tooting they can be prescribed GetUBetter when they present with a MSK condition whilst they wait for their referral. With GetUBetter a digi prescription would work by prescribing the patient who then paid through the NHS app at the same price as prescribed painkillers. The potential for prescribing apps is endless ranging from patients who have chronic insomnia to those that need help to quit smoking or lose weight.
Assurance that apps are safe to use is already undertaken through schemes like ORCHA. They undertake a robust assessment of digital health apps and measures against factors such as clinical safety, data security, usability, technical assurance and interoperability to provide a percentage score and rating. Providing this score allows health and care professionals to select the best digital solution and accurately recommend it to a patient.
With the demand for NHS services increasing every month, and cuts to public sector funding on the horizon we need to transform how we fund digital care, could digi-prescriptions be the future direction for the NHS whilst reducing health inequalities.
Lesley Soden - 29th March 2023
Email – lesley.soden@succoris.com
LinkedIn - https://www.linkedin.com/in/lesley-soden/