The hidden work of engaging with online services: ethnographic case study on digital facilitation

Problem

There is a policy drive in the NHS in England for a digital first primary care service. Whilst some services, including online repeat prescription ordering, online booking and accessing your patient record online are well established, uptake has been variable. The Covid-19 pandemic accelerated the uptake of some online services and the introduction of others. This has raised questions about what support is needed to enable patients and staff to use these services.

Approach

As part of a wider mixed method study looking at digital facilitation in primary care, we conducted an in-depth focussed ethnographic case study, aiming to understand how general practices facilitate patient use of online and digital services. We collected data through non-participant observation, document collection and semi-structured interviews with staff and patients. Sites were selected to include maximum variation in terms of practice size, patient demographics and levels of digital facilitation.

Findings

We recruited eight practices, and conducted 33 interviews with patients and 36 with staff. There was hidden work associated with supporting patients to use digital services. Practices lacked written strategies and policies for digital service implementation including how to support patients. Administrative staff were left to work out for themselves how to support patients and often this work was defaulted to members of staff perceived as tech savvy. A lack of planning for digital support led to a ‘collusion of anonymity’1 where responsibility for implementation and support was disjointed.

Consequences

Policy makers must take account of the invisible work that is required by staff and patients to allow them to engage with digital services. Until there is a clear understanding of the importance of planned implementation and support there will be groups who are underserved by the introduction of digital services in primary care.