Do you watch Dragons’ Den? I love it! Especially when someone pitches for £100,000 for a 2% share in a business that has never actually sold anything. When challenged, they say that ‘it would be worth that £5 million valuation if a Dragon came on board and spent all of their waking hours building the value of the business over the next 10 years’. I remember the couple who had re-mortgaged their house and spent their life savings to develop a bedding range, consisting of sheets and duvet covers with a ridged seam down the middle, enabling couples to have a clear demarcation of ‘their’ side of their bed and save all those arguments. The horror on their face when Peter Jones said that he quite liked it when his wife joined him on his side of the bed. They’d clearly never thought of that scenario!
I love it too when someone pitches an idea, or a product, that (to use the jargon) ‘could disrupt the market’. Deborah Meaden comes across as the shrewdest of the Dragons and is often the one who identifies products with the potential to be really disruptive to current working practices. Doc Abode slots nicely into that description.
If you don’t know about Doc Abode let me explain. It’s a simple-to-use App that enables more effective real-time deployment of clinicians. Behind that simplicity are sophisticated workforce planning and matching algorithms utilising machine learning. Dr. Taz Aldawoud, who developed it, will probably hate me for saying this, but I’d liken it to the Uber App, which of course disrupted the taxi industry. Doc Abode matches the availability, proximity and expertise of a multi-disciplinary clinical workforce to patients needing out-of-hours or primary care whether over the telephone, via video or in their home. It enables clinicians to work far more flexibly as they no longer have to commit to a time-based shift in a fixed location. They can log their availability, speedily accept cases that suit their location and their expertise or ignore those that don’t. Cross-organisational workforce sharing ensures that operational resilience is maintained.
Working with Doc Abode gives GPs and other clinicians the flexibility and independence to pick when, where, and for how long they work. Clinicians provide details of their field of expertise, qualifications, interests, locality, preferred distance of travel and time availability. The software tailors referrals to the skill sets and working requirements enabling GPs, to, for example, see just their own patients, or those close to their location, through a few clicks on their mobile phone. Doc Abode has partnered with Sesui, specialists in providing cloud communications solution to the UK health sector, ensuring that all telephone and video calls are secure, recorded and that call costs are automatically picked up by the service provider.
As someone who has worked for 20 years in wide-area GP Out-of-Hours services, including those covering very rural areas, I see enormous potential in Doc Abode for improving response times and in improving cost-effectiveness. As just one example of cost-effectiveness, an overnight GP covering an 11pm to 8am shift each day would cost something like £350,000 a year. Of course, it never quite works out to need an exact whole number of GPs to cover an area. Say that you need 3.2 GPs to cover those shifts, then the decision we have to take is whether to have 3 GPs and take the hit on response times and meeting performance targets, or having 4 GPs and incurring an additional cost of £350,000 p.a. That is a quandary most urgent care providers face, on an on-going basis.
Using Doc Abode gives you more options. You have the potential for putting 3 GPs on the rota then having additional GPs available to triage remotely, when required, or to undertake a home visit in their local area. You could implement a dynamic resource model with all contacts managed using Doc Abode, or a hybrid solution. Doc Abode arrangements are likely to be far more cost-effective than engaging an additional GP to work a full shift.
Colleagues in urgent care services will be able to immediately identify many pressure points when delivering high-volume services. For example, the high volumes received on Weekend mornings, or on Bank Holidays. Colleagues in Primary Care will have regular pressure points too and incidentally Doc Abode would be an ideal system to use at Primary Care Network level to support initiatives such as daytime urgent home visiting. Or to be really current, used to support high volumes of triage during a pandemic …
With the current challenges in clinical recruitment unlikely to be relieved any time soon, the changing behaviours of the workforce away the traditional model, coupled with the need to drive operational efficiency and provide clinical cover across organisational boundaries, it’s my view that there has never been a better time to introduce an enabling technology like Doc Abode.
Whenever I’ve seen Taz show case Doc Abode on the conference circuit I always hear such positive feedback: “this is fantastic”, “just what we need”, “we want it throughout our service and quickly”. I’ve been delighted therefore to see that a number of trailblazing organisations have already adopted it and I understand from Taz that there are deals in the pipeline with several other CCGs and GP Federations. However, I’m genuinely surprised that it isn’t being adopted universally throughout urgent and primary care. From my own 20 years’ experience in managing urgent care services, I believe that it is going to be especially valuable in out-of-hours settings to improve shift fill. Given its potential to reduce costs as well as improving service quality I’ve been reflecting on why adoption isn’t happening faster.
Many of us have been diverted away from organisational development issues in order to deal with the Covid-19 pandemic and that will account for some of the lag in adopting the newest technology. However, I have another theory; though I hope that I’m wrong on this. For 20 years I’ve been proud to be part of an innovative urgent care sector that moves unbelievably quickly to solve whatever challenge is thrown its way. Right from the days of the GP Out-of-Hours Co-operatives there has been a feeling of empowerment and freedom to innovate in the sector. Social Enterprise providers still dominate urgent care provision and generally are able to move quickly being free of the constraints of NHS processes and unencumbered by the need to satisfy shareholders.
However, has the competitive tendering process blunted innovation? Most Providers are never more than a year or two away from having to fight to retain at least part of their contract portfolio. Is the sector now waiting to see what is included in the next service specification and reacting to that, rather than pro-actively setting itself up to be in the best position to deal with the challenges ahead, as used to happen? So, if the use of Doc Abode became mandated now for all future integrated urgent care specifications it will be become the norm, otherwise organisations will just ‘wait and see’. I hope not as I’ve seen similar attitudes towards adopting cloud telephony and integrated patient management systems. Providers that ‘wait to see’ what new initiative is set out in a service specification, or ‘how things develop nationally’ tend to lose out to those who are more pro-active.
I hope that isn’t the case because when the next round of competitive tenders commences it will, as usual, be the ‘survival of the fittest’. Several innovative providers are adopting Doc Abode and putting themselves in a very good position to compete for forthcoming tenders but I hope that many others will follow. The sector doesn’t need any further loss of good local urgent care providers and I’m particularly keen that the not-for-profit sector isn’t left behind.
About Mark Cockerton
Mark Cockerton joined the NHS in 1978 and has spent the past 20 years leading and managing urgent care services. Mark has established several new Social Enterprise organisations and helped them to secure urgent healthcare contracts. Besides being Chief Executive at 3 urgent care providers in Croydon, Hertfordshire and City & Hackney, he has undertaken a large number of interim roles for urgent care providers including Director of Finance, Director of Operations, Director of Service Delivery, Strategic Advisor, Director of Transformation, General Manager etc.
Having supported more than 25 GP Out-of-Hours and urgent care Providers across England since 1998, in addition to his 4 years as Advisor to the DH Urgent Care Team where he led the implementation of the Technical Links programme, Mark continues to uses his wide-ranging experience to assist organisations in the urgent care sector. He specialises in writing tenders for integrated urgent care services for not-for-profit GP-led organisations that want to compete against incumbent commercial providers and assists in mobilising the new services once the contract is secured.