Exploring the feasibility of developing and embedding a health risk stratification tool for a GP surgery

NHS England delivered their document Supporting general practice, primary care networks and their teams through winter and beyond in September 2022, highlighting the fundamental importance of primary care in underpinning NHS services. A critical part of this plan is to increase capacity outside of acute trusts, which includes the scaling up of additional roles in primary care, increasing the flexibility for primary care networks (PCNs) to do this, and taking further action to support general practice. A key element of this document was for GP surgeries and PCNs use data for improvement to understand demand, activity, and capacity and to improve patient communication through self-care information, community pharmacy options and a range of online services. Currently GP practices are over whelmed with people requiring an appointment – in 2016 the average number of patients per GP practice was 7,761 in 2022 this number had increased to 9,444. Oldham Family Practice are dedicated and determined to develop and integrate a dynamic health dashboard to understand patient healthcare needs, be able to identify and manage vulnerable patient groups in a timely manner, to improve health outcomes and streamline services. The dashboard would allow patients to log into the doctors practice booking system, answer a range of questions related to their health condition and then be offered the most appropriate pathway to follow. The pathway may suggest making a doctor’s appointment, visiting the pharmacy or simply self-managing their condition. Being able to explore systems that can aid patients in their care navigation activity will allow for appropriate use of GP appointments, timely appointments for those who require a medical consultation and saving unnecessary travel to appointment do those who can self-manage. This project aims to investigate and explore the feasibility of developing an online system, which health conditions should be given priority, understanding the cultural landscape and if the information requires presenting in a multitude of languages ensuring equity for all. The project will bring together the practice’s clinical staff, administrative staff, and University staff to meet and explore the potential of artificial intelligence to develop a dashboard for a range of ‘common’ healthcare conditions.

Activities will be 2 meetings to explore the feasibility of developing a dashboard, understand any barriers, discuss if the proposal fits in with NHS Digital guidance and how effectiveness can be measured if followed through. Prof Karen Ousey will advise on medical conditions and Dr Chen will advise re the feasibility of development of the dashboard using Artificial Intelligence. If the proposal is deemed to have merit to be taken forward this would lead to a proof-of-concept project.