Digital transformation across primary care in Greater Manchester

Primary care is the front door to the NHS and one of the most dynamic and innovative parts of the health service. The way we access general practice is changing and much of this change is being enabled by the availability of new digital technologies. However, there is a huge variation across England in how primary care digital transformation is being approached. 

Across Greater Manchester we have had real inconsistencies in adopting digital across people and places. Digital inclusion hasn’t always been at the forefront of the design of tools, alongside not being able to get enough out of our current suite of digital tools. With the pandemic we had a rapid adoption of new technologies without training or investment in our workforce and hardware to support it. This rapid adoption has led to inconsistent deployment and subsequent issues with interconnectivity and interoperability between some of the new digital tools and services. 

In Greater Manchester, we believe that the most successful way to achieve change is through collaboration and partnership across our region

Whilst the rollout of new digital tools and innovation was undoubtedly a step forward, we have some way to go. Unlocking the full potential of the tools we have currently and starting to integrate general practice with wider primary care is a key starting point. 

In Greater Manchester, we believe that the most successful way to achieve change is through collaboration and partnership across our region.

With this in mind, we have worked with the Greater Manchester Integrated Care Partnership, NHS Greater Manchester, and Health Innovation Manchester to develop the Greater Manchester Digital First Primary Care (DFPC) programme, supporting general practice on a digital transformation journey. 

The DFPC programme was formed as part of the national initiative to improve access to general practice. Maximising the use and adoption of digital technology is also a key aspect of the five-year primary care system plan: the Greater Manchester Primary Care Blueprint. 

In establishing the programme, we worked closely with two primary care networks (PCNs) in Greater Manchester to try and understand the operational and patient service benefits associated with digital transformation. We worked with two PCNs with differing levels of digital maturity and capabilities, which was important in informing the DPFC strategy. These pilots gave valuable insight and provided some lessons for me, as well, that I would like to share.

1. Agree intent

Agreeing intent at the start of the transformation journey is crucial. Take time to understand the operating models of the PCNs, federations or collaboratives you work with, and remember that everyone has emotional, corporate and financial investment in their operational models.  Consider the buy in and governance structures of the primary care organisations you work with; keep checking understanding and buy in throughout the process; use workshops to explain the project goals and progress throughout; and make sure individual participants keep their organisations and boards updated.  

2. Funding

Funding is a huge challenge for PCNs, so be clear about what is on offer and what is expected in return. Set out a clear project funding policy with expected outcomes, payment mechanisms, timescales and memorandums of understanding, and ensure you take time to understand what your financial teams need to make payments on time.  

3. Understand motivations

While we were excited at the potential of our digital transformation, not everyone understands or is motivated by digital change.  Articulating how the change will lead to patient benefits, and ensuring the change feels real and tangible for key stakeholders and staff, was very valuable in bringing people along with us. Champions and sponsors of the initiative also helped to create buy in among staff, as introducing change requires a relatively stable workforce. This is particularly pertinent within leadership teams.  

4. Digital inclusion

Digital inclusion must be fundamental in all developments. Ensuring the effective use of data to support digital inclusion, such as utilising the Digital Exclusion Risk Index (DERI) tool, is key to taking the programme forward. This will help us understand some of the drivers of digital exclusion in our region and support working with local authority partners to improve inclusion. 

As with all transformation, it is about people and understanding their needs

Understanding people

But digital transformation is not just about using the latest digital tools to deliver primary care. As with all transformation, it is about people and understanding their needs. Primary care digital transformation needs to focus on how we can provide safe and effective services with excellent user and provider experience so that we deliver services that are fit for purpose in the modern world. 

It's vital that we utilise and support primary care provider collaboratives, allowing providers to come together and collaborate with the system on future innovation.  Stakeholders within integrated care systems must work collaboratively to keep pace with digital developments in primary care, championing successful innovations and work on scaling and spreading these. This will ensure that primary care continues to drive forward and ‘keep up’ with the inevitable challenges that we will be met with in the future. 

We are not there yet in Greater Manchester, but I am quietly confident that by continuing our collaborative approach, we can strive to implement digital transformation that will support our primary care system to thrive for the benefit of both patients and the workforce.

Dr Chris Nortcliff is a practising GP, GP digital lead and part of the Greater Manchester Primary Care Provider Board delivery team. Chris is also a member of the NHS Confederation's Primary Care Data and Digital Group. You You can follow Chris on X @chrisnortcliff