Hierarchy disruptors: bringing specialist knowledge from hospital to community careBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l4376 (Published 28 June 2019) Cite this as: BMJ 2019;365:l4376
All rapid responses
Thank you, Dr. Mann, for your comments about ECHO and the thoughts expressed which highlight concerns expressed by other GP colleagues across the UK in these days of ever increasing pressure.
As a GP, I hugely valued the opportunity to learn from and be supported by my colleagues in my local DGH on Friday lunchtimes. Sadly those days have all but disappeared across the UK as the demands on practice have exploded. I fully agree with Dr. Mann that this has been a vital loss and my hope is that for some, ECHO could provide an opportunity to regain a little of that significant loss through enabling regular contact and contribute to rebuilding trust between primary and secondary care.
One of our recently started ECHO networks, called ”Mind the Gap” links a DGH with the primary care community who refer most of its patients with the specific goal of improving understanding of issues faced from both sides of the referral/ discharge interface.
ECHO is a methodology committed to building trust and support through collaborative problem solving across such interfaces rather than any particular software package.
There is no financial cost involved in engaging with project ECHO which has been supported through philanthropic and government funding here in the UK. The approach has been found helpful in a wide range of countries and health care systems right across the globe.
The ECHO patent about which Dr. Mann expresses concern is not linked to any particular video conferencing software nor is it focussed on preserving the commercial success of project ECHO.
The patent was taken out to try to prevent ECHO from being used by those who would seek to make commercial capital out of the methodology - the commitment to collaborate and share knowledge and support to the benefit of patients particularly those in underserved communities.
If in the future nobody remembers the name ECHO but the movement has encouraged a more collaborative, networked and less siloed way of caring for patients in our hard pressed NHS that will be a huge success for ECHO in the UK.
Professor Max Watson, Director Project ECHO, Hospice UK
Consultant Palliative Medicine Western Trust
ECHO and the NHS https://vimeo.com/297946237
Competing interests: I am Director of Project ECHO at Hospice UK.
Catchy name, but ECHO appears to be less disruptive innovation and more a US-patented product being sold back to the NHS as 'something new'. Notwithstanding the many differences between primary and secondary care, and their relationships, in US and UK, pre-demise of the NHS we did have fantastic liaison with outreach education from hospitals by specialists serving exactly this purpose. While we still do have hospital-based education sessions which aim to upskill GPs, fewer and fewer of us are able to attend, largely due to relentless escalation of non-clinical meetings for management, commissioning, audit, referrals, pathways, prescribing and more.
Patented videoconferencing ? Clinicians simply need the time back to do what we have always sought to do for ourselves. Perhaps hailing 'project ECHO' is more an acknowledgement that we have lost something vital to Medicine: the cohesion of clinical networks where clinicians support and educate each other to keep pace with evolving evidence, to inspire debate, and achieve the best possible outcomes for patients.
It may be that ECHO has better functional video-conferencing IT than does the NHS (not difficult), but that only serves to highlight the lack of will thus far to develop the best technology for, and by, the NHS.
Competing interests: No competing interests