Notes: Patient Online Workshop: Crewe – 27 November 2013 1

Notes: Patient Online Workshop: Crewe – 27 November 2013
Patient Online Workshop – Crewe events – 27 November 2013
Objectives for the Workshop
The workshop was one of two organised in partnership with the National Association for Patient
Participation (N.A.P.P.). Objectives were to:
• understand patient experience of the online services that already exist in GP practices;
• share and develop ideas on how patients can get involved in implementation of Patient Online,
including looking at the potential role of Patient Participation Groups (PPGs);
• discuss how best to develop patient champions and advocates across England to encourage wider
take-up of these services; and
• seek views on how to communicate about the aims and benefits of Patient Online
Attendance and format
30 participants attended the workshop.
After an introduction to the Patient Online programme (POL), patients had the chance to voice their
questions during the Q&A Session. Attendees shared current experience of online services with their
GP practices, and then participated in a group exercise, which allowed them to discuss the potential
benefits of the Patient Online: appointments booking, secure electronic communication between
patients and practices, repeat prescriptions, and access to patients records.
Finally, patients worked in groups to generate ideas for patient involvement in Patient Online.
The attendees concluded that the event provided a good opportunity for networking and significantly
increased their knowledge of the Patient Online programme. Participants’ quotes are captured on slide
1) Will the Patient Online programme have cost implication for GP Practices? If so, how much would it
Many Practices have already introduced online services. The online services (appointment booking,
repeat prescriptions, access to test results, and records), will improve during 2014/15 (go live April 2014)
with the introduction of the revised GP System of Choice framework, which will be centrally funded. And
by March 2015, all practices will have the facilities to offer the above-mentioned services.
2) Patient Online is an additional system, and not a substitute of the current one. Have you considered
that this could be hard to understand for those people who are not computer literate?
There is a programme of inclusion through NHS England (working with the Tinder Foundation) to deliver
training in digital skills and supported access to technology.
We also know that peer support and ‘helpdesk’ type support can be very helpful in enabling people to
access these types of services, so we are looking at ways to develop this as well.
3) Will surgeries have a private area/place where people can log in?
Yes, we would encourage surgeries to have a computer terminal where patients can log in and use the
online services – a few do this already.
4) EMIS is a private software company - will GP practices and patients be forced to use their system?
There are 5 different companies that supply computer systems used by GP Practices in the UK. However,
GPs have the choice of what system they want to use (which will be centrally funded) and Practices will
open up technical interfaces in order to provide services to patients.
At the same time, patients will have choice about how they connect to their GP practice, using free
internet and smart phone applications.,
5) Patients will gain access in the first place to their personal records. What about the security system?
Yes, but Practices will help out with regards to non IT-users, and they will actually feel much more
integrated in the new system.
6) 7 Million People still do not have access to the Internet. Some of them are disadvantaged and do not
have a computer, while others are just not interested in having one. I cannot see an easy solution for
these cases.
Libraries, community facilities and internet cafes provide access to the Internet, so there are possibilities
for people without computers to access online services that way, or via their phones.
However, this will not replace the traditional ways of accessing information and making appointments, so
these methods will still be available.
Benefits of Patient Online from Patient Perspective
Group Exercise
Attendees were asked to describe the benefits of each of the main
functional areas of Patient Online:
I) Online Appointment Booking
II) Secure electronic communication between GP Practice and Patients
III) Repeat prescriptions
IV) Access to patient records
Responses have been organised into three categories;
• Benefit
• Suggestions
• Concerns/questions
I) Appointment Booking
Instant access anytime of the day or night
Actually see when a particular GP is available
It is difficult to get through the phone so online booking is
Easier to do appointments online than wait in a queue on
the phone
Time and money saving
Commence system between Hospitals and GPs
Make sure non IT- Patients have equal access on the phone
In order to register, you have to complete a form and return
to the practice two days later to pick up the “password”
presumably to prove who you are
Online booking needs to work in real time with phone
booking – use same system
Bookable consecutive appointments
More access for non-English speakers
Only applies if practice decides to allow this. They are
Confirmation that your appointment is booked
Need a simple URL to access – say rather
than complex ways of accessing
Surely, when you have completed the form, you should be
notified direct by e-mail, and given your password that way
People do not understand how the system works, so they
should be educated
Limiting number of appointments is good when patients
want to see the same doctor
Will a percentage of appointments be available to book
online, or all of them?
Our practice only gives access to appointments,
not prescriptions or personal files. No advantage to register
for online services
Too much demand for appointments available
What happens if more than one person books the same
appointment slot?
Different GP surgeries have different appointment
system/ethos. This adds confusion to patients
Challenge for surgeries
Online system doesn’t work for urgent appointments
Can only book future non-urgent appointments – need to
have access to book an appointment on the same or next
day too, or not worth using
Can’t book appointments far enough in advance either
online or at GP surgery
II) Secure electronic communication between GP Practice and Patients
• Remote access to professional advice. In own
locality via IT-link
• Not leaving home unless consultation required!
• Saves a journey – supplements telephone
• Gives more flexibility
• Efficient because reduces work for receptionist,
saves a salary
• Sorts out simple queries, e.g. prescriptions
• Really accessible for deaf people
• Skype is free (face-to-face)
• Audit trial of your own
• E-mailing photos – useful advice whether to
• Over expectation! How to manage?
• Timely response
• Tailored, appropriate health advice
• Possibility of email contact out of hours
• Would be useful to be able to ask questions as a
follow up to a GP consultations – easy to forget at
the time or think afterwards
• Benefit of email if it is a secure email
• Benefit of emailing at a time for the patient that is
convenient to them
• Need assurance on response time to emails
• Pilot initially with non-GP clinicians!
• Need assurance of consistency and timelines
• Guidance on parameters and expectations – on both
• Email contact – need one address to ensure action.
Many GPs do not work 5 days a week
• Good – but need guidance on when appropriate to
use electronic communications and when a face-toface is needed
• NAPP meeting for Monitor. Would you prefer to see
a GP of your choice?
• Convenient for patient, but is it also convenient for
• Concern on GP resource to handle
• Does the surgery have a capacity to cope with live
communication online? Concern over “who” you are
communicating with – is it your GP or a nurse in the
practice, or not?
• Security: what stops private organisations placing
adverts on your information?
III) Repeat prescriptions
• Online prescriptions are greener, less pollution
• Direct access to chemist – home delivery
• Emergency medicines – who has access? Patients
who are not online should be given a written list of
medicines, to take on holiday – to be shown in
emergencies, GPs etc.
• Time saving
• Flexible. Amounts of meds ordered – i.e. insulin
• On-line prescriptions need work – explanatory notes
for patients
• Online queries: medications?
• Medical review date: GP reminder
• Patients on long term insulin use should be able to
have at least 2 months’ supply
• Repeat prescribing: a function to order current oneoff items that you require, but not on a regular
• Local pharmacy checks monthly with patients to see
if items are all needed
• Getting the correct drugs
• No way to feedback about medicines  still need to
make appointment
• Consensus – too many versions of repeat
• Automatic pharmacy renewal wastes resources –
tax payers’ money
• Repeat prescriptions need “vetting” – some patients
will order drugs they do not need monthly
• Drugs on different repeat periods of time
• Refusal of a repeat  patient confused?
IV) Access to patient records, test results etc.
Need access to the summary
Can take a copy with you abroad
Test results – when they should be available?
Sharing with out of hours services
Letters from consultant – yes
Tests available to patients who can self-manage
Able to find errors – data cleaning
Should have guidance on how to use it
Reminder of advice given
Will empower people
Will save resources as info available
Format is important – e.g. an overview
Out of hours medication
Could share with (other) clinicians – e.g. when records haven’t come yet
This is not a replacement
Access becoming law
Faster access to test results
This highly volatile info? Some patients could take drastic actions if they knew where certain info came from (e.g. its
Some GP Practices do not allow access to records by patients without obstacles being put in the way
Confidential info: provided by other people for the GP
Planning patient involvement:
1) How can we build patient awareness and demand for these services?
GPs and nurses to promote in consultations
Pharmacy staff to promote
1:1 Discussion  talking to patient in the practice waiting room
Practice publicity:
New patient pack
Free service (right hand pack of prescription)
Surgery Business Card: telephone number, website access
Write to or email all patients
Write to all patients who “DO NOT” attend surgery
‘Next time you can do it online’
• Clear statement of what it is:
No jargon
Plain English
• Per practice basis  different/tailored ways
• Develop a partnership between the Practice and PPG
• Social marketing  segmentation. Eg Young person promotion – ask them for ideas on how to
• Via professional dealing with specific groups  understanding barriers  different messages
• Condition-specific websites
• Patients group
• Locality based messaging
• Crewe area federation of PPG  April 2014: conference/networking
Planning patient involvement:
2) How can we support patient champions for this programme?
Ensuring given accurate information/crib sheets
Updates of changes
Part of group/network
Access to I.T. advice/support
Feedback regarding teething issues/errors
Strategic levels – two way information
Any patient that has the interest, enthusiasm and energy
Champion in each surgery
Messages must be consistent
Go via volunteer groups – e.g. Age Concern
Go via health advocates in a PPG
Who will take responsibility for information?
Which organisation will they be representing?
Use Social media / twitter
Info facilitators/know-alls patient friends
Topic for Locality/Federation of PPGs
Planning patient involvement:
3) How might PPGs/individual patients be involved in this programme?
PPG could put pressure on or support
practice to implement
PPG work with GP’s, staff with feedback to
PPGs could promote this to Individual
patients and could support champions
Need to know their commitment
Practical things – paper, computer, etc.
Leaflets, hand-outs
User acceptance testing
Using their area of interest
Targeting specific conditions
Making them aware of what is expected,
so they don’t get disillusioned
Focus group involvement
Varying medical needs, interests and
experiences across all demographics
Desks in practices to promote
Reception staff involved
Don’t torture ourselves to get everyone
Computer terminal in surgeries
Show pts through online check in
Information for leaflets, newsletters ,
displays in surgeries, posters
- Systems
- Email = Do not forget system for patients
not online
- Online
- Text to mobile
How to contact/engage younger fitters
Use virtual PPG
Use emails from PPGs
Planning patient involvement:
4) What support would they need?
Invited to events, conferences
GP’s may not agree with all suggestions/choices
Communication via NAPP and other rates
Federating (on a CCG footprint) make it worth coming to it; working groups
Mixing with people out of area
Working across boundaries
Refreshing (members change)
Stronger role of NHS England
Communication tool kit
Delivering letters in local PPG
PPG should be first to know
Email + sms
Central point of contact
PPG should be patient champions
Understanding people’s barriers
Community/Groups involvement (e.g. access skills)
Signposting Services e.g. Information prescriptions
Feedback on workshop organisation
Whilst the majority of respondents were satisfied with the quality and key aspects of the events, some
of them commented that future events would benefit from addressing the following issues:
• more NHS England/HSCIC engagement across the UK, to convey the message that patients input
was valuable;
• provide name badges or labels to break the ice and to start conversations among attendees;
• improve the quality of power point presentations;
• simplify the admin process to book on to the workshop
• better use of microphones.
Patient Online Workshop – Crewe – 27 November 2013
General comments/ from graffiti
you for
on a
“Why is there not
one system across
GP Practices
“The choice of
supplier may lead to
confusion amongst
patients – we need
one portal”
“Patients need to
have very easy
access to the
Online access might not be
accessible for patients where
English is not first language. GP
practices should have in place a
toolkit and/or leaflets in
appropriate languages which
explain what kind of info you can
access, how to do it and why.
“There should be
consistency in system
– similar or same for
“Please test
the running of
“Doctors are asked to
do too much on stuff
that are not related to
the care of patients”
Want to know more about Patient Online? We welcome patient
participation in the programme. For more information contact Frances
Newell at NHS England; email [email protected]