How are staff and patients supported to access and use digital services in primary care? Interview study with stakeholders

Problem

The adoption of NHS digital primary care services has been encouraged in England for some time. Whilst some services, including online repeat prescription ordering, online booking and accessing your patient record online are well established, uptake has been variable. With concerns around digital exclusion and inequalities, it is unclear what is actively being done to support patients or staff in using these services (i.e., ‘digital facilitation’). The aim of this study was to explore the views of national, regional, and local stakeholders around the drivers, priorities and policy context influencing digital facilitation.

Approach

As part of the Di-Facto study, online semi-structured qualitative interviews were conducted with stakeholders, including those in the NHS England infrastructure, third sector organisations, providers of digital services and patient representative groups. Interviews sought to explore the policy context, drivers, enablers, and challenges to digital facilitation. Interviews were audio recorded, transcribed in verbatim and analysed using an inductive thematic approach.

Findings

Nineteen stakeholders were interviewed. Stakeholders articulated an ambitious vision for online primary care services that may align patient experience to that experienced in other sectors such as retail and banking. Current key drivers for digital services were identified as the need for efficiency within general practice, and rising patient demand for access. In terms of digital facilitation, stakeholders were aware of the concept, but could not easily identify policies designed to support in practice. There were varied views on who should be responsible for digital facilitation and for priority groups needing support. Barriers to the use of online services were seen to vary by patient group, which included affording internet and handsets for homeless groups, managing evolving technology for the elderly, and confidentiality for those with mental illness. In some cases, barriers to accessing digital services felt to be beyond the remit of the healthcare system to address.

Consequences

The study indicates a perceived need for support in the use of online services in primary care, but a lack of clear guidelines to drive this, and differing views on where responsibility lies. Well-developed digital facilitation requires investment, support, resources and training, which are not consistently available in primary care. Some patient groups, particularly marginalised groups, may require targeted digital facilitation approaches which are tailored to their needs. Together with other findings from the Di-Facto study, our recommendations will guide the future development and implementation of promising approaches to digital facilitation.