On April 1st things changed at Appt. They changed a lot and quickly. April 1st was the first day of an 18-month project to transform the delivery of preventative healthcare in the London Borough of Barking and Dagenham (LBBD), funded by Innovate U.K. and led by Appt Health, the social enterprise that I founded back in July 2017.
It was also my first day as a full-time employee at Appt, having been working part-time at DrDoctor since January 2018. I was joined on day one by two full members of staff from LBBD and within the month by an additional three full-time members of the Appt team.
Suddenly it all felt very real. Just-like-that I was up to my neck in organisational tasks and planning. Appt had become a funded company with employees, sought after partners, and an important problem to solve.
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Appt was first commissioned in Barking & Dagenham in the summer of 2017. Pye Nyunt, the Head of Insight and Innovation at LBBD wanted us to run a pilot in two Barking GP surgeries of an 'automated call and recall' prototype that I had been cultivating in my spare hours.
The pilot results were positive. Appt's use of automation and intelligent SMS messaging saved GP surgeries time. But more importantly, it reduced the barriers that patients typically face when they access preventive healthcare appointments. The sample size was small, but our prototype platform already showed clear signs that we could deliver high uptake rates for programmes like the NHS Health Check.
We got together with the GP Federation (Together First) and LBBD to form a consortium that applied for Round 3 of the Digital Health Catalyst programme. A programme funded by Innovate UK as part of the Industrial Strategy Challenge Fund.
One of the challenge themes identified by the fund focuses on 'Healthy Ageing'. The ‘Health Ageing’ category has a clear target: helping everyone to enjoy five extra years of healthy, independent life by 2035, whilst reducing health inequalities - the gap in healthy life expectancy between the richest and poorest in society.
My vision for Appt fitted these goals well, so together we filled out the form to enter the application process for funding.
The money enables Appt to get serious about our mission. And, the first step was to design a trial that will prove our technology works with statistical significance (our methodology, goals, and progress will be posted on this blog in another post). Which is an important step for gaining the trust of the healthcare community.
In June and July, we quickly implemented our MVP in 18 GP practices in Barking & Dagenham, where we are in the process of a randomised control trial (RCT) that covers more than 4,000 patients who are eligible for an NHS Health Check. By the end of March, this will allow us to provide evidence that our methodology works, before we scale nationally.
At Appt, we are building tools that make it easier for GP surgeries to deliver preventative healthcare services. Our tools also lower the barriers that patients face when accessing the appointments that help them to live healthy, independent lives free from preventable ill health. So, our challenge is twofold: to support delivery, whilst improving accessibility.
We're doing this by working closely with all our stakeholders. Patients, to understand the needs of the people who will use our service, members of staff in practices, to design solution that fit into their day-to-day, and, commissioners, who pay for these services to be delivered. We believe that any solution that doesn't work for all three of these stakeholder groups won't get far off the ground.
Booking a preventative healthcare appointment is currently painfully difficult, and most people give up as soon as they reach a busy GP practice phone line. If we can reverse this by making the booking and attending of appointments a walk in the park – then we will significantly increase the uptake of preventative healthcare programmes.
However, an important part of the puzzle to helping people live longer, healthier lives through prevention lies with making the process easy for care providers, too. When preventive care becomes burdensome, it seems to be the first thing to be crowded out by the day to day rush of practice life. If the process is simple, automated, and effective, we expect to see GP practices become highly engaged users.
We see evidence for this in the large variation in uptake between GP practices and across regions of England. For example, some practices conduct NHS Health Check's on 0% of their eligible patients, and a small minority reach 100%. This can lead to screening rate statistics that, on a surface level, look good (i.e. a high average). But, when you have a closer look they reveal that not everyone is receiving the same level of care.
This variation is, in part, driven by the time-consuming process of engaging patients in screening programmes. And, that's where the puzzle piece of simplifying prevention for care providers is key.
By making preventative appointments highly accessible for patients whilst reducing the burden of engaging patients for care providers, we think that we can make preventative programmes highly effective.
And, what’s more, we can do it in a scalable way. That means that, although we are starting in Barking and Dagenham, our horizon stretches to national and even global solutions to preventative healthcare delivery.
As we move into the middle third of our 18-month project, the team plan to write much more frequently about Appt's progress, news, and our methodologies, as well as thoughts on sector trends, best practice in GP practices, and the major problems we see in health care today. Head over to our 'About us' page to get further insight into the team, our company goals and our values.
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