I became Lead Service Designer on the Register with a GP surgery service back in June 2021. We started where all good designers start, by looking to understand. Through research, observations, and conversations, we focused in on who we were designing for, their experiences and the problems we needed to solve.

We worked closely with pilot practices to understand different approaches to registering patients. This insight helped shape the service and the collaboration demonstrates how we benefit from each other’s expertise.

My colleague Tamara Farrar has written about how we tried to ensure that the new service was accessible to all sections of the population.

I am going to focus here on what the design of this service does that makes it more than just an online form.

Registering with a GP surgery is the start of a relationship between a patient and their practice.

Doctors, nurses and other practice staff need to have enough information about the person joining them to offer great care immediately. For the person registering, it’s about transferring or starting their care successfully – and as quickly as possible.

It became clear very quickly that registration had to go beyond the collection of the minimum personal demographic data collection. Simply digitising the existing GMS1 form was not going to meet the needs of either patients or GP practices.

‘So, isn’t that just a longer online digital form?’ you might ask. Not really.

First, let’s start with the format itself. Rather than using a long form on a website, the service uses the ‘one thing per page’ standard used across government and NHS services. Research has shown time and time again that this format helps people:

• understand what you’re asking them to do
• focus on the specific question and its answer
• find their way through an unfamiliar process
• use the service on a mobile device
• recover easily from form errors

Currently, practices can ask people registering a range of different questions, in addition to the information required in the GMS1 form. The online service aims to strike a balance between gathering the information that GP practices need and making the service simple and easy to use.

Only asking what is necessary at the point of registration removes unwarranted or unnecessary variation across GP practices. Every patient using the online service will experience a consistent registration process – including those who traditionally find it hard to access NHS services. GP practice staff can still request additional information from patients once they are registered and also have the option to customise some elements of the online service.

But beyond the form and the questions asked, it is what is going on behind the scenes that elevates the ‘Register with a GP Surgery’ service from just a digital form.

To optimise data quality, the service uses lots of different techniques. One example is field validation, an automated process that helps to ensure data input errors are minimised. If a person types a mobile number and misses a digit, the validation recognises this and shows an error message. All of the error messages are written by experienced copywriters and tested with people to ensure they are understood and can be easily corrected.

A significant proportion of the UK population have either permanent or temporary impairments or disabilities which need to be taken into account when developing digital services for the public.

To address this, all public sector bodies are legally required to meet the Accessibility Regulations 2018. To ensure we are designing a service that can be used by everyone, the service is regularly tested by people with accessibility needs, as well as having a full accessibility audit and meeting the WCAG 2.1 AA standard.

While designing this service, I observed practice staff inputting registrations onto their systems. One task I found interesting was the Personal Demographics Service (PDS) trace. On the surface it is simple: you enter some data to match the patient to their record. This is incredibly easy if the person knows their NHS number but, let’s be honest, most don’t! In more complicated scenarios, practice staff are forced to adopt a forensic approach, finding different ways to be sure that there isn’t a match. In many cases, a call to the patient is inevitable.

We wanted the service to be able to help with this and, ideally, eliminate unnecessary work by matching patients to their PDS records and providing practices with the patient’s NHS record. The team have worked hard to design and refine the algorithm and we now have a match rate of over 80%. This will continue to be a key focus and an area of continuing improvement for the service.

My observations and discussions with practice staff over the past 15 months have revealed the pain and annoyance a rejected registration can cause. The principle of rejections is sound. They happen because something isn’t right. However, analysis shows that sometimes these are avoidable. For example, a lot of issues arise when the registration type selected by the practice doesn’t match the type on our national systems. This is one of the most frequent rejections, accounting for 29%.

To help to avoid this, the service has been designed to be able to derive the registration type from data provided by the person registering. This is then shared with the practice to use when submitting the registration. We are going to closely monitor whether these solutions are working in practice.

The service benefits from being part of the wider digital ecosystem of the NHS, making integration with other services really simple. So far, the service has integrated with NHS login, providing a faster way for people to provide their registration information. It also provides practices with an authenticated email, mobile number and matches the patient’s registration with their NHS number.

The team are currently integrating with the Find a GP service, where people searching for a practice can see those offering online registration.

Both ‘Find a GP’ and ‘Register with a GP surgery’ will soon be using a new catchment API, which means people will be provided with GP results that are in the catchment area for their current address. This feature will dramatically reduce the number of people trying to register with a surgery outside their catchment area and in turn reduce the number of people practices have to reject.

Integration with clinical systems such as SystmOne and EMIS Web is a major priority, with the potential to save even more time for practice staff, and, looking at the patient experience, we want to offer patients a route to register with a new GP through their NHS App or account.

Finally, our research showed how complex and time intensive it can be for practices to keep abreast of policy. We observed significant variations in how practices interpreted or implemented policy. We work with policy, security and legal experts to ensure that the central service always meets the latest standards. We hope that this will reduce burden for GP practices.

This is just the start, but it’s a great start. It’s really exciting as a Service Designer to see how far we have come and how much further we can go.

If you have questions about the service, please contact [email protected].