GPs continue to do battle with government over telehealth

Health secretary Jeremy Hunt supports telehealth which could be a catalyst for service integration and patient empowerment. Photograph: Graham Turner for the Guardian

The greatest benefits from telehealth are yet to come – as a catalyst for service integration and patient empowerment. But these will only be realised if doctors stop looking for opportunities to reject it.

The development of telehealth has been dogged by politicisation of the issue and the way the conclusions of the "whole system demonstrator" programme were interpreted and debated.

Health secretary Jeremy Hunt is firmly committed to telehealth. The day after the publication last November of the first NHS Mandate, identifying its priorities for the coming years, he confirmed that seven pathfinders run by the NHS and councils would be signing contracts to provide access to telehealth for 100,000 people this year.

In the poisonous relationship between the Department of Health and GPs, ministerial support for a big expansion in the technology is interpreted by some doctors as yet another attempt to impose politically motivated change on the way GPs work.

The whole system demonstrator programme showed that telehealth secured significant reductions in mortality and emergency admissions. However, London School of Economics researchers concluded that "telehealth does not seem to be a cost-effective addition to standard support and treatment", claiming that quality adjusted life years provided by the programme cost £92,000, compared with the National Institute for Health and Clinical Excellence ceiling for cost effectiveness of £30,000.

Pitched as the biggest telehealth research project to date, and with a name that gave the misleading impression that it was a definitive answer, the conclusions provided sceptics and cynics with ample ammunition. In particular, some GPs resistant to signing up to telehealth programmes have been citing the demonstrator as evidence that it is a wasteful diversion of scarce resources.

But the weight that has been given to the LSE researchers' analysis is a mistake. It is all but a certainty that the cost for each person will fall as use of the technology becomes far more widespread, and that its effectiveness will increase. Improvements in performance will be driven by targeting its use to the patients who will benefit most and, crucially, by more sophisticated use of the information which it provides.

Telehealth technology is not particularly clever – the really clever part is the human system within which the technology is used. Community nurses, paramedics, GPs, consultants and above all the patients themselves are the essential tools of telehealth. As they become more experienced in analysing and acting upon the information which the technology provides, and different services around the telehealth patient become more integrated, patient benefits and cost effectiveness will rise.

Eventually, other costs will start to fall as telehealth becomes a catalyst for wider system change. At present it is a bolt-on to a care system poorly integrated and not adapted for telehealth. It will require clinicians to work together in new ways, particularly in more effective joint working between community and hospital staff. It offers the prospect of ending the drudgery for both patients and clinicians of thousands of pointless outpatient check-ups which daily clog up hospitals. Users should require fewer GP appointments.

But the biggest benefit will come from providing patients with long term conditions with the encouragement and information to manage them more effectively. Patient empowerment must be central to any plan to exploit this technology.

Talk of "expert patients" and "patient empowerment" far outstrips improvements in the involvement of patients in managing their own care. But telehealth is an opportunity to improve people's understanding of their own health, give them a greater voice in decisions – such as deciding the right response to a particular reading – and perhaps most importantly encourage them to be less dependent on meeting clinical staff.

Telehealth has much to offer a financially constrained and struggling health system which is looking for better ways to meet the needs of older patients and others with long term conditions.

Concern among GPs that the primary care system is being overwhelmed is not matched by a willingness to explore new models of working. Telehealth deserves a better hearing from many doctors than it has had so far.

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