Digital facilitation in primary care, a focused ethnographic study of the experiences of staff, patients and stakeholders.

Problem

The NHS is under pressure due to the increasing demands of a growing and ageing population and changing expectations amongst the public. Recent NHS policy in England has advocated the greater use of digital services, with a vision of a fully digitally integrated primary care service. The Covid-19 pandemic has seen the rapid development and use of digital services within primary care. Some patients may require assistance in setting up and/or using digital services, which has been termed digital facilitation. Digital facilitation may be important for patients who struggle to navigate digital primary care services. This study aims to understand, from the perspective of practice staff and patients/carers, the potential benefits and challenges associated with different models of digital facilitation in primary care.

Approach

This work, part of a large study of digital facilitation in primary care, used an in-depth focused ethnographic approach in eight general practices sampled to include a variety of demographic characteristics. As part of focused ethnography interviews were conducted with practice staff (n=36) and patients/carers (n=33).

Findings

Digital facilitation was seen as valuable but was poorly conceptualised, and it was often unclear where the responsibility for digital facilitation lay within the practice. A range of approaches to digital facilitation were identified; proactive, reactive, or a mixture of both. Reactive approaches were observed in practices, where digital facilitation was provided in response to individual patient need. Digital facilitation was often conducted by members of the administrative team who lacked formal training on digital services and associated technologies. We observed embedded attitudes about who needs digital facilitation. For instance, assumptions were made about who may or may not be able to use digital services which were not necessarily grounded in evidence. Different groups of patients had different needs in relation to digital facilitation. Individual circumstances were important when it came to the need for digital facilitation.

Consequences

Successful digital facilitation needs dedicated funding, infrastructure and staff training, not currently accessible in primary care. For the NHS to reach its ambition of greater use of digital approaches in general practice, targeted investment and support are required in staff time and training. Some patient groups, such as marginalised groups, may require tailored digital facilitation approaches customised to their needs.