Improving the NHS’s most fundamental process

“There was a mum sitting in the waiting room. She had just given birth,” says Pashova, digital and transformation lead at the Harrow East Primary Care Network. “When I told her about the new digital application form, she went straight on her phone and she had completed her child’s registration in 3 to 5 minutes. That’s it.”

There were more than 6.8 million GP registration applications by patients last year. While seemingly routine, Pashova says, the Register with a GP surgery service’s simplification and systematisation of this most fundamental of NHS processes – the gateway into NHS care – is a major time-saver for providers like hers and a boon for patients.

“They can register at any time, day or night, without having to fit in with practice opening times. They no longer need to be physically present at the surgery, which is especially helpful for those who may have mobility issues, live further away from the practice, or have busy schedules. It is accessible. It’s easier for people without English as a first language as it can be used with online translation tools and there are standardised paper forms for people who need those. It’s just better,” she says.

Register with a GP surgery was launched in August 2022. The central offering is a simple and standardised online registration form that is fully integrated with patient-facing digital services like the NHS App, NHS login and NHS Find a GP.

More than 1,900 GP practices are now live and the service is processing about 20,000 patient submissions a week.

William Leachman, an enrolment lead with the service, says integration with NHS digital services is a key part its appeal.

“A patient registration doesn’t really start with completing a form. The patient has to find the GP in the first place. We’re connected with the NHS Find a GP service. So, when they put their post code into Find a GP, links will come up showing relevant practices and, for those that have signed up to Register with a GP surgery, patients can just click through and start registering,” according to Leachman.

Integration with the NHS App adds approximately 33 million recorded app users with swift access and NHS login users have information such as their NHS number automatically available from their accounts.

Leachman says many 16 to 35 year olds expect a digitised service and adopt it immediately, but that the service's 93% patient satisfaction rating across all age groups shows a strong general appeal. For the minority of patients for whom a digital service isn’t appropriate, Register with a GP surgery offers a standardised and accessible paper form.

From practices’ point of view, the service not only helps their patients but saves lots of time. Register with a GP surgery is matching patients to their NHS numbers with a 90% match rate and enrolled practices are experiencing about 3-times fewer ‘exceptions’ requiring resubmission to Primary Care Support England (PCSE), the national body processing new patient registrations. This reduction in practice staff ‘detective work’ saves a lot of time that can be used for other things.

Pashova says, the efficiencies are obvious in the back office: “We spend less time on tasks such as photocopying, scanning paper registration forms and manually uploading them onto clinical systems. It’s saved a huge amount of admin time and has made the process faster – and, of course, it reduces the time that patients need to wait for the surgery to process their registration application.”

Nicola Frisby, a digital services manager with NHS South Central and West Commissioning Support Unit with long experience of working with registrations in primary care, says that, while many registrations are straightforward, they can take a lot of time when problems arise.

Sometimes necessary information is not filled in, is inaccurate or illegible, she says: “It’s not unusual to not be able to read the email or the phone number and, if you have problems with contacting people, it really does take a lot of time getting the information you need.”

The new system’s automatic catchment area checks take out more admin for practices who need to check patient's locations.

The service is still working to achieve the full integration with GP clinical systems that would allow a direct flow of data from the digital form into GP’s records. Currently, a standardised PDF is generated and sent by email to the practice, allowing staff to easily paste information into their system. There are also paid-for 3rd party services that allow direct transfer into the systems.

Gary McFegan, Digital First Project Manager at North Central Integrated Care Board (ICB), says full integration would receive a roar of approval from the user base, but he says the existing system is already an obvious step forward.

“We previously ran an 18-month digital registration pilot with 45 practices in North Central London using a different solution and were thrilled with the 22,000 new digital registrations we achieved. All of the practices involved have now transitioned to the Register with a GP surgery service because it matched or exceeded their experience with our previous solution.

“Even before we decided as an integrated care board to implement the national service, some of our practices had signed up independently, as they viewed the national tool to be a better option for them. When you have something that is a patient-friendly digital registration option and can also reduce practice admin, it’s going to be a winner.”

There had been initial scepticism from some practices but their doubts tended to reduce with use.

“Some questioned the time saved by registering the patient digitally compared to the traditional method. Some preferred a face-to-face process with ID checking due to concerns about identity. The national service’s use of NHS login has helped address the ID issue and the time saved is clear – although it rapidly gets absorbed. It just lets our practice staff do other things for patients,” McFegan says.

A dedicated implementation team is working with ICBs, primary care networks (PCNs) and individual practices to switch on Register with a GP surgery access – in a matter of minutes, in many cases.

Support is tailored to the local context. For example, when working with an ICB with many practices within its area with differing needs, the central team might take part in an initial call with practices to explain the service and take questions. Support on communications is provided, with professionally produced communications materials and web-based information provided centrally, and there’s practical support for surgeries that are struggling to get online.

“If an ICB is wondering about bringing this to their area, we can now tell them it's already in their area,” says Nick Hopkinson, associate director of strategy and engagement on the project. “We’re live in all 42 ICBs across the country and in some areas about 75% of practices are already signed up. We have a dashboard that allows you to look up your own area and see which practices near you have already signed up. So, colleagues can find out who you can talk to locally about this.”

Recent improvements have been made to make it even easier for ICBs to adopt the service across their area. All that is needed is 3 pieces of information – practice name, ODS code and a shared inbox email address – to enable bulk enrolment with the support of the NHS England onboarding support team.