An abridged version of this article was originally published by Pulse on 24 June 2019
No one needs to convince GPs that technology can improve our working lives, helping us provide safer care for our patients.
We are, by and large, tech enthusiasts –likely to have the latest gadgets in our pockets or strapped to our wrists. We’ll use apps to manage our household finances or book a holiday, and we welcome new digital tools that give patients more choice and flexibility with how they interact with the health service.
One big change this year is the introduction of the NHS App.
More than 8 in 10 practices in England have been connected to it so far, with more being linked up every day.
Most patients can create an NHS App account and verify their identity from their sofa at home. They can then book and cancel appointments, view their summary care information, manage repeat prescriptions, set organ donation and data-sharing preferences and use the NHS A-Z symptoms checker and 111 Online triage service.
Two thirds of patients registering on the NHS app are newbies to using GP digital services, which suggests there is a strong desire for patients to use digital to interact with surgeries.
We are working with the market to enable the NHS app to act as a digital front door for other innovations, such as video consultations.
Its introduction won’t be a magic bullet solving our challenges trying to meet the demand for appointments. But, as an additional channel for patients to connect with our services, it can help us manage those pressures more effectively.
Patients get frustrated being kept on hold to speak to a receptionist or being met by an engaged tone. But spare a thought for the receptionists dealing with this. What is the opportunity cost to practices of receptionists having to put so much time and energy into this daily flurry?
The app can help. Patients booking and cancelling appointments online 24/7 automates an administrative task, freeing up time of practice staff.
Make enough appointments available
The new GP Contract obliges all practices to make at least a quarter of our appointments available to book online by July. Practices are sometimes reluctant to relinquish the triaging skills of their practice staff, especially when demand is so high.
I understand those reservations and instinctively share them. Typically, on a Monday, in addition to a routine clinic, I also work an emergency session managing the telephone triage list. The list has effectively no limit and I admit, the thought of offering online booking for these sessions fills me with that snowed under feeling. Importantly, when patients phone, our experienced reception staff can often support many without them needing to speak to a doctor. And with our diverse inner city multi-cultural population, sometimes patients simply need some signposting or clarification questions that our reception staff can help with. But the truth is that booking appointments online is the future – soon we will regard it as commonplace as using apps to transfer cash or book train tickets.
This means needing to trust – and educate - our patients to use tools enabling them to book appointments online responsibly. Practices can disable online booking ability for any patient who abuses it, so we aren’t losing control.
At my practice in Southampton, we make all routine appointments and smear tests available online. Our practice was linked up to the app last November and we have 215 patients using it so far. To date they have used the app to book 124 appointments, cancelled 31, and ordered 195 repeat prescriptions. Small numbers for now, but they will grow as more patients download the app.
We’re finding it works well and does free up some time with less admin work to do each day and a modest reduction in phone calls. And if I was to think without that snowed under feeling, maybe we should offer some of the triage telephone slots as online appointments – test it out slowly, in a measured way and see if our patients use them effectively.
Make appointment names clear
The effectiveness of taking this approach relies upon clear and simple appointment names. We are a long way from that now and it needs action.
Appointment names have traditionally not been patient-facing, they have been used for administrative purposes. But the lack of any standard around appointment naming means there are tens of thousands of varieties in the system, and it is flummoxing patients.
In a recent poll of NHS App users, when we asked whether patients understood the names of appointments, more than two thirds found them confusing.
On a couple of occasions patients even mistakenly reported thinking they were seeing someone else’s appointment, because they were looking at the first name of the clinician they were due to see. An inconvenience while the app has around 25,000 users, but potentially crippling once it has millions.
This requires action from us at the centre and work is underway looking at creating a standard for naming appointments. But we cannot wait for that – we need practices to do their bit now and act to ensure their appointments are named so patients booking them online or via the app can easily find what they require.
Embrace the app
We all know that we need more GPs and that our workforce is the most important part of our health service. But, at a time when there is no magic bullet, we must dip into every little efficiency gain and benefit we can achieve. At our practice, we have found taking a measured approach to rolling out the NHS app has given us another channel to work with our patients, whilst releasing staff time for other work. Patients love it and there is something satisfying about knowing that my surgery is embracing being digital! Hmmm… perhaps a few online emergency appointments isn’t such a bad idea after all…
See Guidance for GP practices on the NHS App for more information on how to prepare your practice for the NHS App, including making appointments available for online booking and changing the names of appointments so patients can understand them.