Technological innovation. What having a wee tells us about it’s place in general practice.

I’m staring at the blue circle of death. 

No, I’m not revisiting Windows in the mid-90s, this is a 2023 web-based GP patient system. I clicked on my next patient and there it is again. Every cloud (-based service) has a silver lining, and here it’s that unlike the computers of my youth which would get perpetually stuck on the azure wheel, at least this one is temporarily 5 seconds, 10 seconds. This is a slow death by a thousand clicks.

It has been making me nostalgic for the pre-cloud era. Despite looking like something out of the 80s in the late 2000s, when you pressed a function key the response was immediate. Ever wondered how much time we lose to that little blue circle every day? (Timing it is going on my next PDP…)

The new NHS Long Term Workforce Plan encourages us to “embrace technological innovations”. Don’t get me wrong, I love new technology but we need to question what added value it brings to general practice.

Take the simple urine specimen. Give people a pot, let them go to the loo, in moments they return with a sample. Is this a problem that needs solving? Research published in this month’s BJGP highlights that women generally agree an alternative to the small plastic pot (not the easiest of receptacles to aim for) would be welcome. Also contaminated rates are as high as 30%, meaning a lot of repeat wees. In step ‘urine collection devices’, specially designed contraptions that aim to make collecting urine easier and in some cases automatically catch the midstream of a sample. Did women feel this was an improvement? Mixed responses. While some found them straight forward to use, others found them like a puzzle to construct, and being slowed down is the last thing you need when you’re fighting urinary urgency. The real hammer blow is linked research from 2022 showing a failure to reduce mixed growth rates compared with the standard pot. 

What about medications? There are a whole host of new drugs, clever biological therapies, but as a recent BMJ paper points out many of new medicines treat the same problem in the same way, lacking additional therapeutic value - only “one third of drug approvals by the FDA or EMA for initial indications were rated as having high added therapeutic value “. In addition, pharma companies often apply for secondary indications for drugs, which the authors found to have even lower chance of adding extra value beyond existing available medications. The benefits of choice are often extolled at this point, but what about the benefits of a lack of choice? The Yorkshire Healthy Hearts program showed improvements in tens of thousands of patients’ high blood pressures when clinicians used a simplified hypertension pathway containing only amlodipine, indapamide, losartan and spironolactone.

But wait, what about the magic cure for the NHS: artificial intelligence? Touted as having the ability to replace repetitive tasks, it won’t be able to sign prescriptions, make a cup of tea, or take a wee for you. Its main role may be in triaging patients but we need to be careful what we wish for. AI is simply a computer following an algorithm. We already have algorithms – it’s what 111 follow and we all know what happened to unnecessary ambulance callouts and A&E attendance. Add in a bit of machine learning and we might be able to bake in some of the discrimination against women and minority groups which has plagued research and healthcare for years. Computers can’t solve a workforce crisis, only adequate numbers of appropriately trained staff can.

The blue circle of death dies before I do and finally I can phone my patient. It’s a complex conversation about new diabetes and the role of medication in a person in their mid-80s. He tells me he struggles on the phone so I bring him down to the practice. The relief on his face when he comes in and can look me in the eye as we discuss his health is palpable. No technology will ever be able to replace that.