Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 12, 2020
Date Accepted: Jun 4, 2021
The effect of 24/7, digital-first NHS primary care on acute hospital spend: a retrospective, observational analysis
ABSTRACT
Background:
Digital health has the potential to revolutionise healthcare, by improving accessibility, patient experience, outcomes, productivity, safety, and cost-efficiency. In England, the NHS Long Term Plan promised access to digital-first primary care for all, by 2023. However, there are few fully digital-first providers around the world and limited research into the cost-effectiveness of such solutions from a health system perspective.
Objective:
To evaluate the impact of highly accessible, digital-first primary care on acute hospital spend.
Methods:
A retrospective, observational analysis of acute hospital spend on patients registered to a 24/7, digital-first model of NHS primary care compared with other practices in North West London Collaboration of Clinical Commissioning Groups. Acute hospital spend data were obtained under a freedom of information request. NHS techniques designed to fairly allocate funding according to need were used to standardise or ‘weight’ the practice populations. This adjusted the populations for characteristics that impact healthcare spend, for example, age, sex, and deprivation. The total spend was divided by the number of standardised, or ‘weighted’ patients to give the spend per weighted patient, which was used to compare between the two groups in the NHS Financial Years 2018/19 (FY18/19) and 2019/20 (FY19/20). FY18/19 costs were adjusted for inflation to make them comparable with FY19/20 values.
Results:
: The NHS spend on acute hospital care for 2.43m and 2.54m people (FY18/19 and FY19/20), across 358 practices and 49 Primary Care Networks, was £1.60bn and £1.65bn, respectively. The spend on acute care per weighted patient for Babylon GP at Hand members was between 12-54% (£93 - £389, P=.047 - P<.001) and 15-51% (£114 - £362, P=.006 - P<.001) lower than the regional average in FY18/19 and FY19/20, respectively. This amounted to lower costs of £1.37m - £11.6m in FY18/19 and £3.26m - £18.8m in FY19/20 for the Babylon GP at Hand population.
Conclusions:
Patients with access to 24/7, digital-first primary care, incurred significantly lower acute hospital spend.
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