HCPs, how many patients have you met who don’t know that their GPs use online systems for messages and appointments? Patients, if you know about these, do you know how to use them? Patient Access remains a good system, but there is scattered use amongst services – and I don’t think enough people are aware of its existence. The NHS app can place part of its success in forced use resulting from COVID. But the competition in varying patient platforms means that not all GP surgeries make full use of the NHS app. All I can do on it, asides from viewing my GP record of course, is order repeat prescriptions. That, notably, is suitably easy to do on the app. My GP surgery uses the e-consult system, a handy triage and appointment-booking system in one package. But to access it I need to go to my GP surgery website, which seems to change its layout every so often. I then need to find the correct tab, answer some questions that are often unrelated to my complaint but serve to update my GP record, and type something in the box that makes it clear to my GP that I do need their help.

There are issues here, and these are personal bug-bears:

• Knowledge, and knowing what to write – A large majority of people do need to be triaged to ensure they are accessing the correct service, but those who have tried various services before, or are contacting their GP at the appropriate time may not know what details the GP really needs. HCPs know that a young, healthy person asking about a cough that has been going on for a few weeks has approached primary care services at the right time compared to a person who has just written ‘cough’ in the field. As frontline clinicians, we are more receptive to an explanation from 111 rather than ‘cough,’ especially as this is likely to be a wrong-service wrong-problem kind of issue. If we as patients think we need a referral for ear problems, we know the GP is likely to realise the importance of our e-consult if we have written that we have already tried x antibiotic and had the problem for some time. For pain, have we already tried pain relief and other self-care solutions? We are more likely to put this in the field and, I would argue (though this is an opinion piece), we are subsequently more likely to have a faster and more appropriate response to our complaint. In my experience of seeing patients frontline, many of our patients would not know what to write. Health literacy rates are poor in this country (Gursul, 2022), and as Jones et al (2022) highlight, e-consult was launched without GP-surgery led implementation (read: training).
• User confidence – I have many colleagues and friends, from various generations including my own, who are not confident using new systems. I have personally sat with people and coached them on how to use Office software or find system icons settings for their computer. I know many people feel overwhelmed by new systems and some feel overwhelmed by pre-existing systems. Learning their use requires patience and a belief that it is not going to be impossible to learn. Not having either of these leads to frustration. Again, patients have not been shown how to use any systems except, perhaps, the NHS app during COVID lockdowns – and even then that was only if they paid attention to adverts on social media. Our elderly patients are unlikely to see any of this content. Confident use of a system comes with regular use, yet many of our patients are unlikely to use these systems regularly.
• Access – Some patients do not have smart phones or cannot afford internet access. We cannot find a solution that works for everyone, but we must give everyone the best opportunity to access the options available to them. As the small study (Jones et al, 2022) shows, GP surgery websites do not meet access requirements, and e-consult systems are not easily accessible for all patients. Some patients I have met did not even know these systems existed. GP surgeries need to do better to educate their patients and improve their websites. E-platform creators need to do better to advertise and make their systems accessible. A 2021 study by Bryce et al found awareness of online services in the West Midlands was at 60.8% – however, the authors found this percentage was more likely to consist of patients who used the Internet regularly and regularly saw their GP. That 60.8%, then, are patients who are more comfortable to technology and more exposed to healthcare providers. 60% might be over half, but that still leaves many behind. Patient groups should be on top of issues like this, raising them with their practices and pushing for better practice – but then, is their health literacy and awareness above 40-60% of the UK population? (Gursul, 2022). They must remember that as soon as they engage in health content and have the ability to analyse the information they receive, they are no longer representing the majority. An article by Clarke, Dias, and Wolters (2022) might conclude that ‘non-digital users’ are not ‘disadvantaged’ by online services, as long as traditional services continue, but many patients and HCPs alike will highlight the difficulty produced by large populations accessing GP surgeries by telephone – they are not call centres and cannot handle huge influxes of queries. People might not be disadvantaged, because they can still attempt to access the way they always did access their GP – but they are certainly not advantaged. In my experience some patients say they have not tried to call their GP because they didn’t believe they would get through, or because, as some elderly patients have said, it just isn’t as easy as it used to be.

In summary, I am suggesting that many patients don’t know what to type in fields that ask about their complaint, and many patients do not know how to use e-systems – even if they know that they exist. And, in a negative health culture, in which people expect to face issues dealing with health services, are people motivated and patient enough to learn these new systems?

I am not suggesting these systems cease to exist – I personally think they are beneficial, and I like most new technology. However, I do think we need to educate, encourage, support, and mentor our patients to utilise what is on offer.

HCPs and patients, what do you think?

References

Bryce C, et al. 2021. Online and telephone access to general practice: a cross-sectional patient survey. BJGP Open. 2021 Aug 24;5(4):BJGPO.2020.0179. doi: 10.3399/BJGPO.2020.0179. PMID: 33910917; PMCID: PMC8450875. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450875/ (Accessed 28-Dec-2023).

Clarke, C. Dias, A. and Wolters, A. 2022. Access to and Delivery of General Practice Services. Available at: https://www.health.org.uk/publications/access-to-and-delivery-of-general-practice-services (Accessed 28-Dec-2023).

Gursul, D. 2022. NIHR Evidence: Health information: are you getting your message across?; June 2022; doi: 10.3310/nihrevidence_51109. Available at: https://evidence.nihr.ac.uk/collection/health-information-are-you-getting-your-message-across/ (Accessed 28-Dec-2023).

Jones, RB. et al, 2022. Use and usability of GP online services: a mixed-methods sequential study, before and during the COVID-19 pandemic, based on qualitative interviews, analysis of routine eConsult usage and feedback data, and assessment of GP websites in Devon and Cornwall, England. BMJ Open. 7;12(3):e058247. doi: 10.1136/bmjopen-2021-058247. Available at: https://bmjopen.bmj.com/content/12/3/e058247 (Accessed 28-Dec-2023).

**Opinion post by Article 999 founder