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Sunday 23 October 2016
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Talking leadership

General practice is working hard to survive but with strong guidance its future prospects are on the up. Ian Dalton CBE, president of global government and health, BT Global Services, discusses how he sees things panning out for primary care

Primary care is under increasing amounts of pressure. With the government insisting on seven-day access, patients’ expectations rising and difficulties in recruiting GPs it’s fair to say that general practice has a dark cloud hovering over it.
General practice is in a phase of transition where it is looking to other ways and means to keep up with demands. To meet the challenges that the NHS and in particular general practice faces, there must be strong leadership. While there are a number of experiments taking place across the country in the form of vanguards, pioneers and local pilots it is the dissemination of any success that will help to improve the NHS as
a whole.
Ian Dalton CBE, president of global government and health, BT Global Services, appreciates the hard task primary care faces but sees the opportunities that need to be grasped. Speaking to Management in Practice, the former chief operating officer and deputy chief executive of NHS England discusses the importance of leadership.
“Looking ahead, leadership needs to be really bold. So the fact of the matter is that healthcare systems round the world, and the UK is no exception to this, are facing unprecedented degree of change and challenge over the next decade.” Dalton puts the ageing population and patient expectations at the top of the list of possible reasons why primary care and the NHS as a whole is under such strain.
He says: “Left unattended those challenges will put huge and probably unsustainable pressure on all aspects of healthcare systems. The quality of leadership that’s needed to make a difference to that is what’s really going to be significant over the next few years.
“I was privileged to be a leader in the health service myself for many years working at local hospital levels, at regional levels and at national levels, apart from the fact it was an immensely rewarding career, it was immensely challenging but brought home to me the importance of leadership in creating change.”
With an ageing population putting an increasing demand on healthcare, primary care has had to think outside of the box in order to meet these changes. Dalton admits it’s a hard task to meet and a challenge for any leader, even of the most experienced.
He understands the unusual position of managing in the NHS. An organisation created to help with people’s health but that must also function as a business.
“It’s really important that there’s a degree of commercial acumen there, that’s absolutely vital. It’s vital for general practices; these are businesses that have to sustain themselves. So being commercially savvy is part of the expectation and being able to engage with staff brilliantly is part of the expectation. Being able to set out a compelling vision for the future, maybe one that challenges the way services are typically provided, because we can do better, is really important.”
In the NHS a manager’s skillset needs to contain an understanding of not just the business side but the clinical as well. For Dalton it is important to “have the ability to work brilliantly with people providing the care”. He says: “You need to be able to gain their confidence, gain their experience and their expertise and ultimately you deploy that to help them become more successful at their job of delivering patient care.”
Management and leadership in primary care now goes beyond the four walls of the general practice. In order to meet the expectations of patients and the government other useful tools are being introduced.
Digitisation of the NHS has long been on the agenda albeit in many different forms. And this is an area where the BT health president feels primary care could benefit. According to Dalton, BT has had positive results with its telehealth system. The system is designed to help monitor patients’ long-term health conditions within their own home, therefore freeing up doctors’ time to see other patients. It works with a plug-in device in the patient’s home that’s connected to the internet. It has a range of capabilities to assess their health status: blood pressure, oxygen etc.
According to Dalton, “almost any long-term condition can be monitored”. The plug-ins sensors take the reading, that’s uploaded automatically into a monitoring sensor and the person’s data is automatically set against pre-set levels. “They immediately get reassurance that their levels are normal but at the same time if something’s happening that’s abnormal there’s an early warning opportunity so that they can take action at the beginning of an issue rather than when it becomes a crisis,” he says.
“The opportunities for linking this in with the care pathway are really quite simple. Either the person themselves, or their carer can be alerted or there’s an opportunity for the nurse in the monitoring centre to be able to notify the practice if that’s an issue as well.”
Patients can also be referred to it by hospital consultants and A&E but it is “usually grounded in general practice” with GP referrals.
He adds: “General practice is one of the gems of the NHS so it’s really best that the referral comes from the person that knows the patient best.”
The are 1,100 patients currently on BT’s telehealth system that also allows video consultations with doctors. The results so far have shown that 90-94% of patients are happy with the service.  
The NHS, however, also has to run like a business. And Dalton is honest about the financial aspects of it. He says: “The health service will typically pay for this and will get the benefits in terms of more appropriate service use. I’m optimistic about [telehealth] but I note that the role out in this country has been relatively slow.
“It’s not a panacea, technology isn’t. It’s about integrating general practice, which is a phenomenal thing we have in this country and has the responsibility and the skill to look after people with long-term [health needs], and to help people to be able to manage their own health as part of that care pathway.”
While telehealth can free up time in general practice there are concerns around the security of patient confidentiality.
As Dalton says: “Security is critical in the NHS and I think never more so than today. We have huge capability in protecting patient data. I think perhaps broadening the question out a bit we see security as one of the rising issues on the agenda of health services in the UK. We know that the threat level is rising from external attacks. We know that there are risks to very sensitive information in healthcare.”
Dalton recognises that “the NHS is now stepping up to the plate and protecting it’s own critical networks”.
He says: “The future of information security I think becomes even more important in a digital age where more and more people interact digitally with the health service and want their data to be completely secure. Whether you’re in a general practice at one end where you contain important patient data on your computer system or whether you’re running, overseeing the whole of the NHS network at the other end, there’s a role for everybody in [data security].”
Going paperless is a long-held ambition for the NHS, and given that we live in a world that has become increasingly digitised it should be possible for the NHS to move in the same direction.  
“I think general practice has led the way and many practices are very close to being paperless.”
The father of two sees the main challenge being the need to join everyone up so that all health and social care professionals are able to access patient records online. In 2013, BT Health launched Interoperability that enables this to happen. Having already been active in Birmingham the idea is that with Interoperability, general practice, hospitals, community services, “almost anywhere that provides care to a patient can input and access a patient’s records, at a click of a button – it’s very powerful”. This information can also be made available to the patients through a patient portal as patients “increasingly expect to have access to their own records”.
Having held an array of roles in the NHS Dalton highlights his position as chief executive of the NHS North East because of the “sheer magnitude of opportunity we had”.
With a healthcare system for about two and a half million people “we started off pretty well,” he says. “We had the shortest waiting times in the country, the best response to patients needing A&E, we had very strong financial balance sheets, so in some ways we had the highest patient satisfaction. At the same time we knew we could be so much better. We knew we could do more to improve the way we looked after patients with long-term conditions, in an aging population. “We knew we could do more to help manage patients properly in the community, patients with mental health issues; it was a huge privilege to be able to run that healthcare system. I’d like to think that the work we did along with doctors, nurses and health professionals from across the whole of the region laid some foundations for significant improvement.”
One major leadership task for Dalton was overseeing the creation of clinical commissioning groups (CCGs). He says: “Well I was very optimistic about the engagement of clinicians in local leadership decisions, it’s a really powerful medicine, if you like, for the ills of the health service.”
Although Dalton has championed clinical leaders in the form of CCGs he recognises the huge change in primary care over the last few years.
He says: “Primary healthcare teams are really important, rather than just always focusing on the skills of the individual practitioners.”
But Dalton, like any leader, looks
to the future and focuses on improvements in order to sustain a much needed service. “The key for
me going forward is the integrated system of healthcare, supported by
the right technology and obviously we [BT health] would like to play our part in that.
“I’m very optimistic about the NHS. I think we’re on the cusp of some great changes.”