Professor John Campbell, Professor Gary Abel, Professor Helen Atherton (Warwick), Jon Sussex (RAND Europe, Cambridge) and other colleagues from the Di-Facto team – APEx seminar 6th December 2023.

Posted by ma403

6 December 2023

Supporting people in accessing and using NHS online services – digital facilitation in primary care.

For many years now getting things done online has been part of everyday life, whether that is booking train tickets, doing your Christmas shopping, booking a hairdresser appointment, or paying bills. Why should interacting with your doctor be any different? Well in many ways it isn’t, with services like booking appointments, ordering repeat prescriptions, and accessing medical records having been available at most general practices in one form or another for some time. With the pandemic came the need to use these online services more, as well as the wide-scale adoption of electronic consultations, use of text messages and to a lesser extent video consultations. However, online services may not be easy for all patients to use, and it has been suggested that those that need health care most may be least likely to engage with them leading to a possible digital inverse care law. For this reason, we undertook the Di-Facto project, funded by NIHR, to look at the role of Digital Facilitation in primary care. Digital facilitation is a term we coined for the study and we have defined it as “that range of processes, procedures, and personnel which seeks to support NHS patients in their uptake and use of online services”, or in other words the stuff that general practices put in place, or do, to help patients to use things like online consultations and appointment booking.

The Di-Facto project comprised of four complementary work packages, most of which took place over the pandemic when online services were becoming increasingly important. The first thing we did was to review the literature to see what people had already done. Secondly, we conducted a survey of practice staff, a survey of patients, and performed a secondary analysis of the national GP Patient Survey data. Thirdly we undertook some ethnographic case-studies with researchers embedded in 8 general practices for up to 6 weeks at a time, and interviewed a number of key stakeholders. Finally, we brought the findings of all of the work packages together in a synthesis and outlined the key aspects required in any future evaluation of digital facilitation. The results of these studies will be coming out in a series of papers over the next year, but some of the key findings of the synthesis are given below.

Digital facilitation took many forms and could be both passive and active as well as proactive or reactive, with passive (such as the use of text messages or emails) and reactive (such as ad-hoc help and advice) forms being those that were most often used.
There was a continued focus on initial sign up rather than sustained use in both the existing literature and the facilitation efforts we observed, and while this may help initially, it may not lead to long term change.
There was often a lack of responsibility and accountability for digital facilitation, which although recognised as important, was often seen as somebody else’s job.
One of the key enablers of digital facilitation was a clear rationale for the digital services themselves. Practice staff were much more likely to engage with patients to help them use a service if they themselves could see clear benefit, with a similar effect on patients.
And finally, while there was a clear awareness that some patient groups were more in need of support than others, this didn’t always translate to those groups receiving that support and there was a lack of strategy for helping those in marginalised and vulnerable groups.

Online services are here to stay in the NHS and simply waiting for the population to catch up is unlikely to be the best way to maximise their benefit. Digital facilitation may provide one way to realise the promise of efficiency gains and better access that many people envisage when they think about the digital NHS.