How are staff and patients supported to use online services in primary care? Findings from qualitative stakeholder interviews

Problem

The adoption of NHS online primary care services has been encouraged in England for some time, although Covid-19 has seen an acceleration in uptake. Online services including appointment booking, ordering repeat prescriptions, and viewing patient records have been available to patients for over five years. With concerns around digital exclusion and inequalities, it is not clear what is actively being done within primary care to support patients or staff in the use of expanding services, or those who may require particular help. We refer to this support as ‘digital facilitation’. As part of the Di-Facto study, the aim of this study was to explore the views of stakeholders around the drivers, priorities and evolving policy context influencing digital facilitation.

Approach

Semi-structured qualitative interviews with 15-20 stakeholders. An initial stakeholder mapping considered relevant stakeholders at national, regional, and local level in England, including those in the NHS England infrastructure, Clinical Commissioning Groups, third sector organisations, providers of online services and patient representative groups. Mapping informed recruitment and a snowball sampling approach was used to identify further stakeholders. Interviews sought to explore the policy context, drivers, enablers and challenges to digital facilitation, including broader issues of access and digital exclusion. Interviews were conducted by phone or Zoom/Teams, audio recorded, and transcribed using a professional transcription company. Transcripts are being analysed using an inductive thematic approach.

Findings

Early findings suggest that there is awareness of the concept of digital facilitation, and that key drivers for online services include GP demands for efficiency, patient demands for access, the business investment aspects of general practices, and the pandemic. Stakeholders were mostly unaware of what is being done to guide practices in digital facilitation and what policies exist. Receptionists were thought to be key in digital facilitation. Perceptions exist that improved access to online services leads to more GP demand, and provision for a future redesign of the front end of primary care as concierge-type. Individual barriers exist for various vulnerable groups, including affording internet and handsets for homeless groups, managing evolving technology for the elderly, and confidentiality for those with mental health issues. There is lack of agreement on who the priority groups are for accessing online services.

Consequences

Policy is likely to support the continued expansion in use of online services in primary care. It is evident that there is not a common understanding of what digital facilitation is available, or clear guidance on what this should be. The views of broader stakeholders are often not included but show that looking beyond the practice is important. Together with findings from other components within the Di-Facto study, recommendations will be provided for future development and implementation of promising approaches to digital facilitation.