Roundtable report: Faster, smarter, healthier

The NHS in Scotland is at a critical moment in its history. Relentlessly growing demand and a shortage of capacity is leading NHS leaders to seek innovative ways of meeting patient needs. 

Better use of digital technology is key to driving improvements, according to the Scottish Government. It is seen as one of the main ways to make the NHS’s limited budget go further. 

In primary care, the pressures are particularly acute. In what ways can digital tools help GP surgeries manage patient demand and improve access to care – and how can hard-pressed staff be encouraged to buy into all this change? 

This was one of the central questions at Holyrood’s round table event Unlocking Preventative Care in Scotland: Leveraging Digital Tools to Improve Access, Relieve Pressures and Forge a Healthier Future, held at Dynamic Earth, Edinburgh on 18 February.

Eight figures from the digital and healthcare sectors discussed in detail how to overcome the barriers to rolling out digital solutions within NHS Scotland.

The event was sponsored by Accurx, which provides software in primary care settings, and chaired by Accurx business development lead Eleanor Rafe. 

“There are 889 GP practices in Scotland and that has reduced over the last few years,” said Rafe. “How can we do more with less?”

Accurx supports GP practices in England and Wales with software that helps healthcare professionals communicate with patients. Accurx developed the software by working side by side with primary care staff. What started off as a platform supporting GPs to make antibiotic prescribing decisions, with a built-in tool allowing practices to message patients about side effects, has grown to be used for a huge range of communications.

Accurx software is now used by 98 per cent of GP practices in England and has 200,000 staff users across the NHS in primary, community and acute services, hospices, care homes, opticians and other settings. 

The firm is expanding into Scotland, with eight practices currently piloting the products in Lanarkshire and Lothian following information governance (IG) approval.

Having a digital product which improves healthcare communication is one thing; implementing it and rolling it out is another. Barriers to implementation include getting IG approval at local, regional and national levels and encouraging staff to embrace change.

Chris Mackie, director of digital at the Health and Social Care Alliance Scotland, singled out one of the key challenges for staff, particularly in social care.

He said: “In a social care setting we are facing bigger challenges in my view and some of those relate to the socioeconomic profile of the workforce.

“We’ve got a lot of literacy issues, not just digital literacy but literacy issues, staff whose first language isn’t English, for example.” He added that the social care workforce was often older and sometimes struggled to adapt to new tech.

Time needs to be created for daytime GPs, to be able to upscale and change across systems

Louise McTaggart, Head of Digital Strategy at NHS Tayside said that staff needed to be given time to adjust to technological change. As an example, she highlighted the rollout of a digital system in Tayside which will allow community healthcare workers to see patients online, using video connections, instead of driving to each individual patient’s home, and how momentous a change it is for district nurses. She said: “It’s about having that lead-in time. 

“We need to be really flexible, not one size fits all, and don’t immediately think we have to do it by a particular day.”

A lack of staff time to learn how to use new tech is another barrier to the adoption of digital tools. Dr Claire McGonagle, deputy clinical director and GP at Lanarkshire out-of-hours service, said it was typical for daytime GPs to work 13-15-hour days. 

She said: “Time needs to be created for daytime GPs, to be able to upscale and change across systems.”

Dr Satya Raghuvanshi, VP of Clinical at Accurx and a former paediatrician, said: “Digital should be an enabler, not something that’s being done to you. It’s the hearts and minds of the staff that are interacting day-to-day with the patients that’s ultimately going to make the difference to how well they adopt it, how well they use it and how much additional benefit they get from any digital system.”

First Minister John Swinney recently announced progress on NHS Scotland’s Digital Front Door platform, which will give people the ability to book appointments and access their health and care information, like blood test results. Rollout will begin at the end of this year, in Lanarkshire.

Jonathan Cameron, Deputy Director of Digital Health and Care at the Scottish Government, noted that the Scottish public had come to expect to be able to interact with the NHS in this way. 

But for tech companies trying to work with the NHS, data privacy and the regulatory landscape are a challenge to navigate. The process is lengthy.

Describing the sign-off process for Accurx, Rafe said: “In Scotland, we got GPs on board, health boards on board, health and social care partnerships on board, government on board, NHS on board, so it took us a long time to get through.

“Reflecting on that, Accurx were a big enough business to be able to do that but if you’re a smaller company I don’t know whether that would be feasible. Is there an argument for how you can test and pilot, fail fast and learn fast?”

Samantha Smith-Garrett, senior innovation programme manager at NHS Lothian, said: “We have 14 territorial health boards, then we’ve got the special health boards, and each have different systems, different information governance requirements, you have the well-known boards that are generally a bit more up for stuff, a bit more lenient, and then you’ll have boards which may have much stricter [approaches], so it’s a difficult space to bring new work through.

“Even within a health board, you go out into the local authorities and various partnerships and there will be different information governance documentation just within that area.” She spoke of the value of a “once for Scotland” approach. Cameron then mentioned that they were pivoting to a “best for Scotland” approach.

Howell said her organisation had to take a similar board-by-board approach: “With CHAS, we’ve done a clinical portal agreement with Greater Glasgow and Clyde health board, but we’ve been told we may also have to do that with every health board.” 

She added: “I have children receiving end-of-life care out of hours, and I can’t see their records. So I think there’s something for me about how we enable this.”

McGonagle agreed, adding: “We’re not a large country population-wise, so I think that’s one of the things from a ministerial point of view that I would hope people would look at – let’s have national guidance and a national IT system and not every health board running something different and adaptations of everything.”

Cameron said such an approach was being taken forward. He said: “There have been national data protection impact assessments (DPIAs) for a number of systems for a long time but that national approach is really starting to come together and I’m really encouraged by that shift in thinking.”

He gave the example of the new PACS (picture archiving and communication system for medical images) a “single, cloud-hosted, national system”.

Meanwhile, there is the question of how digital solutions can help tackle health inequalities. Concern is often expressed about levels of digital literacy excluding some citizens. 

Raghuvanshi said: “I think we make a lot of assumptions about digital inequalities and whether or not people can access some of the tools we talk about. Actually 90 percent of Scottish citizens have a phone that can receive text messages, 75 percent have a smartphone so there is an ability to access that.”

Howell stressed the importance of deciding whether to use online or face-to-face appointments according to patient preference. Being forced to have online consultations during the Covid pandemic may have turned some people off, she suggested, but others saw digital consultations as a benefit. She said: “I used to look after a lot of patients with motor neurone disease who couldn’t speak any longer and actually they really liked NHS Near Me [video consulting service] because they could type into it. 

“For me it’s all around who’s the benefit of face to face for and where that choice is.”

McGonagle said it was important to recognise that the benefits of digital medicine had limits. She said: “During the first round of Covid vaccines I worked rurally. We did over 1,000 patients’ vaccinations, and we picked up nine patients with cancer diagnoses because we had seen our patients and we could see they were short of breath and different things when we were vaccinating them. So we wouldn’t want to get rid of our face-to-face. Medicine is an art as well as a science.”

Yet she added: “Lots of patients do prefer virtual consultations. In out of hours, patients love that at 3am they don’t have to leave the house and get a consultation over the internet.”

Picking up on the point, Rafe said: “It’s not about one solution for all, it’s about providing the right access to the right people and bringing people who have the ability to use digital to use it.” 

No progress can be made in advancing digital healthcare without effective partnerships between the NHS and tech providers, and between different branches of the NHS itself. 

Rafe said Accurx’s experience had been good. In Scottish practices, where the company is working with GPs, she described a “really good collaboration with Teams groups always talking, trying to make sure our product works really well, not just for that practice but for NHS Scotland.”

Even with strong collaborations, though, not all tech firms manage to stay afloat. Smith-Garrett said: “In the last few months, we’ve seen a couple of industry partners who we’ve put a lot of time and effort into go into administration. We’re now having to say what’s next and that’s a difficult place to be in, keeping that clinical service engaged and finding another partner and losing that work that’s already been done. But that’s innovation.”

Digital should be an enabler, not something that’s being done to you. It’s the hearts and minds of the staff that are interacting day-to-day with the patients that’s ultimately going to make the difference to how well they adopt it, how well they use it and how much additional benefit they get from any digital system

Cameron said: “Social care I think is really ripe for innovation and for a greater focus and emphasis. 

“In health there are probably too many players on the pitch in certain areas and part of the challenge we have got as government is how do you pick the ones that are going to survive.”

There is alignment across healthcare settings that change is needed in the form of digital care innovations. Teams must communicate with each other about what is needed and the wins they’ve had, and collaborate with industry partners to make it happen.

The discussion at Holyrood’s round table event made it clear that digital innovation is essential to future-proofing NHS Scotland, but its success depends on overcoming three key challenges:

1. Winning Hearts and Minds — Digital transformation cannot be imposed, it must be embraced. As Raghuvanshi emphasised, staff engagement is crucial – technology should enable, not overwhelm, healthcare professionals. To drive adoption, frontline workers need time, training, and flexibility to integrate new systems into their already demanding roles.

2. Streamlining Systems and Governance — The complexity of Scotland’s regulatory landscape can slow innovation. While progress is being made with national approaches like the Digital Front Door platform and PACS imaging system, the process remains fragmented. A more unified, national strategy – as many experts advocated – would accelerate implementation, ensuring digital solutions reach patients and providers faster and more effectively. It looks like this is underway, and a best-for-Scotland approach is being prioritised.

3. Balancing Digital with Human Care — While digital tools enhance efficiency and accessibility, they cannot replace the human touch. As Howell and McGonagle pointed out, face-to-face interactions remain critical – especially for diagnosing complex conditions and supporting vulnerable patients. The goal should be patient-centered care, offering the right mix of digital and in-person options based on individual needs.

The path forward requires collaboration between the NHS, tech providers, and policymakers to ensure digital solutions are practical, scalable, and sustainable. 

Scotland’s healthcare system is at a crossroads. By embracing smart digital integration, it has the potential to be faster, smarter, and healthier for all. 

This article is in association with Accurx.

Visit the Accurx website for more information on their innovative software for primary care settings.