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Going back to basics — why we are seeing a resurgence in primary care

Discussing why primary care should be championed and how COVID-19 has shown it’s time to disrupt the manner of delivery.

If you think about food, while we all enjoy a fancy meal every now and then — and gosh, are we spoiled for choice here in the UAE — it definitely is not what most of us want to cook (or eat) on a daily basis. In fact, most would prefer a simple, high quality, seasonal meal that satisfies our palate, pocket and nutritional needs.

In the same way, cutting-edge drugs, surgical breakthroughs and the latest specialised medical equipment might garner the majority of attention-grabbing media headlines when it comes to healthcare, but it’s really the quality of the basic underlying system that makes a tangible difference to improving and maintaining long-term wellness. It may be more mundane and less discussed, but primary care really matters.

Changing the narrative

That being said, primary care is sometimes seen as an unwanted gatekeeper, a place you have to go before you can get through to the specialist you think you really need. In fact, during these days of choice, demand and immediate access — particularly here in the UAE — people often bypass a GP and go straight to a specialist.

However, when you break it down, it’s actually primary care that enables the sustainability of health care systems, contains extortionate cost inflation over time, safeguards responsible medical practice and ensures coordination across a range of medical conditions. In fact, it's a crucial first check mechanism before people get into secondary care. That's why we're now seeing primary care having its resurgence. And COVID-19 is showing us how.

Virtual healthcare

Quality primary care has long been associated with a strong physical infrastructure, and with good reason. How can you fully examine a patient, take blood or administer injections unless that person is in front of you? Nonetheless, there is an argument that advocates against the vast over-provision of the physical infrastructure that we currently have — and it’s a compelling one.

The social distancing and self-isolation that we are enduring as a result of COVID-19 has brought a paradigm shift to many behaviours. One of which is in how we choose to interact with doctors. Virtual care has had its ‘black swan’ moment, and the world has opened its eyes to a new way of medical consultation. Here in the UAE, the DHA and many healthcare providers are offering virtual COVID-19 consultations, while some insurers are offering such services as a new or extended benefit in their insurance package for members. As a consequence, digital consultations have gone up 100s of percentage points, consumers have quickly adapted to the change, and even the medical fraternity has embraced a new way of working. COVID-19 has done for digital health in a month what CTOs, CEOs and entrepreneurs have been trying to do for a decade.

Away from coronavirus, if you cast your mind back 20 years, you may remember that GP appointments were only available Sunday through Thursday, 9am to 5pm. This made life very difficult if you were a full-time employee, a working parent or simply needed a doctor out of hours.

Now consider that more than 60 per cent of primary care can be done without physically touching the patient. Taking a good history, getting vital sign readings and/or conducting a virtual examination can be exactly what is needed for an effective consultation.

It, therefore, makes sense to incorporate more accessible, cheaper, lighter models of delivery into the traditional system, which is precisely what the digital environment enables us to do. In 2020, technological advances mean the potential to access a GP virtually — any time, any day, any place — opens up significantly.

Location, location, location

On occasions when physical provisioning is needed, a second issue to contemplate is where we should be offering it. Again, medicine needs to move with consumer demand. As people increasingly look to home delivery in their shopping, it’s time for us to be thinking about similar models for the delivery of primary care.

For a start, it’s simply no longer practical for primary care to be restricted to limited hours at clinics. Instead, we need to think about expanding the infrastructure to include the most accessible prime retail locations, places with good footfall and extended opening times. As a result, we’re going to increasingly see a real push towards supermarkets and pharmacies offering GP units where you can go in and be diagnosed, treated or be given a prescription for minor illnesses. It’s something that is already widespread in the U.S., for example, where CVS already provide retail clinic services, staffed by nurse practitioners and physician assistants who specialise in family care. These are open seven days a week, and no appointment is needed, offering maximum convenience.

Another strategy is having the capacity to consult digitally but to have an UberEats-type network of technicians to take blood and deliver medicines where it’s convenient for patients. Combining this with the latest digital capabilities such as booking a consultation online or via an app can greatly reduce waiting times for patients.

Investment

The final point to consider in this brave new world is where governments and private organisations should be placing their money. The last five years have been flush with venture capitalists and private equity houses going full speed into the space, and large health corporations ringfencing funds. On the other hand, Governments have been starting to change regulation to facilitate further investment, and there has obviously been fast deregulation to meet the COVID-induced demand, most witnessed here in the Middle East.

In the future, all the signs are pointing to the fact that we’re going to see a lot more private and then public investment into getting primary care right, particularly in countries where this infrastructure has been traditionally lacking. Without this, we as a society are not going to be able to meet our own demand for health care.

In short, there is an urgent mandate to change, and all signs point to a resurgence in primary care.

Joe Hawayek, Director - Population Health and vHealth at Aetna.jpg

Joe Hawayek
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