It is clear from repeated domestic and global experiences that primary care has to be the foundation of all healthcare in any country. Even during the current pandemic much of the load of contact-tracing, treating moderately ill patients, and vaccinations, has been borne by our extremely weak primary care networks.
Developed countries such as the United Kingdom have historically relied on highly trained general physicians, each serving small populations of 2,000 to 3,000 patients, to be the first line of defence. This is however not a luxury that many countries can afford and even in the U.K., there are several parts that have been left unserved because of a shortage of GPs.
The use of non-physician healthcare providers has therefore become a norm for primary care in many parts of the world. There is also evidence that no matter how much training is offered, even somebody as well-qualified as the U.K. GP tends to under-diagnose conditions that are rare—such as cancers—because her training and her experience with serving small self-contained populations simply do not adequately prepare her for it.
A much more scalable solution is one in which a vast workforce of healthcare providers is built-up, which is much more rapidly and broadly trained, and, as a part of a strongly supervised network, relies intensively on technology to guide their practice by analysing patient-data and guiding them to get to the appropriate diagnosis and treatment plan for their patients, at the primary care level.
Additionally, with such an approach when a primary care provider encounters a more complex case which neither her broad training nor the decision-support technology that she uses can properly guide her on, using approaches such as those built by ECHO at the University of New Mexico, she can receive real-time guidance and training from a specialist in that field who is based elsewhere.
In highly specialised fields such as psychiatry, the technology can potentially go even further, and when ‘prescribed’ by the primary care practitioner, U.K.-NHS approved solutions such as ‘Wysa’ are able to, for example, directly offer evidence-based cognitive behaviour therapy using an intelligent chat-bot. These solutions were made available during the current pandemic through, among others, a platform built specifically for this purpose by the Swasth Digital Health Foundation.