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Recent years have seen the adoption of online services in primary health care, ranging from booking appointments and ordering repeat prescriptions, through to the use of email and video consultations with patients. These online services have the potential benefit of reducing administrative burden and improving communication and access to healthcare. However, they could also cause greater inequality for those patients who may be harder to reach digitally, such as elderly individuals and those in rural areas or from disadvantaged socioeconomic groups.
To avoid such issues, it is important to understand how primary care practices do and could help patients to access and use online services, including how barriers to uptake might be overcome. RAND Europe, alongside researchers at Exeter University, Warwick University and Bath University were funded by the UK National Institute for Health and Care Research to explore what approaches to facilitating patient uptake of online services are being used by primary care practices in England.
Our study sought to identify, characterise and explore the potential benefits and challenges associated with different ways that primary care staff in England assist and improve patients’ uptake of online services. We used the findings to design a framework for future evaluations of the effectiveness and cost-effectiveness of such interventions, looking at primary care practices’ approaches to facilitation, the impact they are having on uptake of online services, and how such uptake may be impacting patient access to healthcare by different groups of the population.
Together with our academic collaborators and with active patient and public involvement throughout, we undertook a two-and-a-half-year mixed methods study including a scoping literature review, surveys of 156 primary care practices in England and over 3,000 patients, and ethnographic observation at eight sites.
Some examples were found of what we have called ‘digital facilitation’ by staff in primary care practices, that is a range of processes, procedures and personnel providing some support to patients to use online services. However, these were often passive or reactive, rather than active modes of support. It is often unclear where the responsibility for digital facilitation in primary care practices lies and often a lack of time set aside for staff to provide this kind of support.
If digital facilitation by primary care practice staff is to support greater use of online services, this will require:
We did not find one single dominant or preferable model of digital facilitation in primary care. There is a need to co-develop such an intervention with patients, general practice staff and relevant policy experts, which will be explored in future research.
