Facilitating access to online NHS primary care services a focused ethnography

Problem

Policy makers in England have advocated for the adoption of online services in recent years. Some primary care online services, including online appointment booking, ordering repeat prescriptions and accessing medical records have been widely available for the last 5 years, however, take up is variable. The COVID-19 pandemic has seen practices encourage the use of online services, but this raises questions about the ability of patients to engage with these services and the possibility of exacerbating inequalities. One way to ameliorate this is for general practices to support patients in the use of online services through digital facilitation.

Approach

Embedded in a wider mixed methods study, we conducted focused ethnographic case studies that seek to understand in-depth, and from the perspective of practice staff and patients/carers, the potential benefits and challenges associated with different models of digital facilitation. We collected data through non-participant observation, semi-structured interviews and secondary analysis of relevant documentation. Working in three regions of England, we aim to recruit 8 case study sites that demonstrate varying levels of digital facilitation, different practice characteristics and practice population demographics.

Findings

Data collection is currently ongoing. Practices recruited to date include: 5 urban, one semi-urban and one rural; 3 large, 2 medium and 2 small practices. In terms of patient population; 3 practices with high levels of deprivation, 3 with lower levels of deprivation and one in the middle. Data from the first four sites suggests practices value digital offers and therefore the importance of digital facilitation differently. Common to many practices is a lack of overall strategy and shared purpose, understanding and vision among staff members, resulting in much of digital facilitation being conducted ad hoc and to varying degrees by different staff members. Staff confidence and workload appear to be key influences for DF, with younger staff members and those who appear confident using digital services becoming the staff often taking on digital facilitation activities. There appears to be a lack of formal training, guidance and support for staff, and in those practices where some is provided, staff are not always aware of it. There is also potential that these challenges have been exacerbated by the COVID-19 pandemic and expedited rollout of digital services. Some examples of digital facilitation observed included talking patients through accessing systems verbally (usually via telephone), promotional posters, promotion via PPGs, bounce-back emails and pre-recorded telephone messages encouraging patients to use online services.

Consequences

The case study findings will enable us to highlight important barriers and facilitators to digital facilitation and enable us to recommend ways to develop and implement promising approaches to digital facilitation. Emergent findings already indicate potential changes that practices could adopt to enable them to provide more targeted and efficient digital facilitation.