Disruptive innovation… it’s a phrase that’s bandied about but, often, not understood.

Conventional wisdom; disruptive innovation happens when a smaller company, with fewer resources, enters a sector and achieves what’s called ‘market-penetration’.

Incomers pick up segments of the market, ignored by the incumbents, who concentrate on more profitable customers.

Real disruption happens when the interloper attracts mainstream customers. Think Blockbuster and Netflix. Think Uber, Amazon, self-driving cars and 3D printers.

‘Digital’, the accelerator. New digital business models are the principal reason why just over half of the companies on the Fortune 500 have disappeared since 2000.

Now think NHS.

We don’t do disruptive innovation… we can’t take the risk. We have to deliver services that are reliable, safe, consistent and present.

We can’t risk boat rockers in old boats, we need new boat builders…

… that’s why we settle for innovation-lite. Mostly, changes to access or speed throughput, pressured by budgets and resources.

The LTP [Page 28, 1.47] aims to change the basis of out-patient appointments, using remote technologies; web, phone or Skype.

That’s not innovation… it’s sustaining the NHS by improving the relationship with the ‘customer’, using old technology.

It’s common-sense.

A good idea for patients comfortable with that approach, creating head-room to deal more sensitively with the ones who are not.

The real change is not the technology, it’s changing the reimbursement arrangements. Changing the tariff…

‘You get what you pay for, so change what you pay for…’

… is hardly innovation.

The NHS is a slow-adopter of technologies? Probably not entirely true. It’s just a very difficult organisation to sell to. Disaggregated, no front-door and no central grip on what to buy-for-the-best.

What has been very disruptive is Babylon, the GP-in-yer-pocket phone, company.

Hugely popular amongst commuters and the working sick. Mum’s Net has an interesting thread, here.

Over 40,000 people have dumped their legacy GP and signed up with a host practice in London, who offer Babylon.

It’s giving NHSE trouble. How to fund it and how to deal with the impact of migrating patients?

People moving to Babylon practices take their £ allocation with them, hollowing-out the finances of the surgery they’ve left behind. It destabilises practice finances, despite an arcane weighting formulae; rurality index payments and London adjustment payments.

I thought the issue would be resolved in the new GP contract.

Oh no… the BMA were main players and they don’t like Babylon. The new contract isn’t innovative, it’s protectionist.

More of more-or-less the same, for more money.

Babylon will lose just under 10% of their revenues and a new funding stream will be opened up for GPs to set up local, look-a-like, DIY, systems.

By April 2021, just 30-odd months away, all patients will have the RIGHT to on-line and video consultations. Blimey, how?

On top of setting up Primary Care Networks, access to all patient records by 2020, a quarter of appointments available for on-line booking and upgrading websites… plus the day job, this is a tall-order for practice managers to deal with.

Let’s not forget; video consultations still need a doctor, so there’s no benefit for the practice doing it themselves; same patients, different type of access, same doctors.

Real innovation would be, for patients with long-term-conditions; technology assisted self-care and call-centres… specialist nurses and algorithms, in the front-line.

No mention of them in the Contract but it does say;

‘Progress on digital delivery will be important to maintain social solidarity behind the general practice model…’

… and later, [page 34, para 5.7];

‘Some digital models… offer practices the opportunity to buy-in additional clinical capacity.’

Much happier, will be Push-Doc’s white label service. Their biz-model is to provide a video-consultation service, for practices, from Push-Doc doctors, working remotely, but connecting to the patient’s records in the surgery. From the patient’s perspective, it’s their practice.

Local connectivity, giving continuity, adding capacity and diverting flow. No upheaval, just a weblink and a phone. Innovative or resourceful?

It doesn’t have Babylon’s artificial intelligence, reducing the need for a ‘person’.

We’re left with the conundrum;

Can Babylon overcome disruption? Can Push-Doc overcome staffing?

Every once in a while the triangle of technology, a sticky problem and a good idea, turn into an innovation.

Are we there yet?

It brings to mind a caution, passed-on to me by a wise business mentor;

‘Pioneers get arrows in their backsides!’


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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.