Title: Facilitating access to online NHS primary care services - current experience and future potential
Funder: Department of Health and Social Care

Abstract: Due to growing pressure on Health Services in recent years, there has been an increase in the use of internet-based services in General Practice (GP) Surgeries. This includes the ability to book appointments, order repeat prescriptions, as well as offering an alternative to face-to-face consultations via email and video. With a drive towards an increased provision of these services, it is important to understand any ‘barriers to use’ and how they might be overcome, particularly in order to ensure fairness in the provision of healthcare to different groups of people. One way to ensure this is with digital facilitation; supporting NHS patients and carers in their use of online services. _x000D_ _x000D_ The study aims to understand:_x000D_ • How the use of internet-based services are advertised and supported in GP Surgeries._x000D_ • The benefits and challenges of different approaches used to support internet-based services for patients and staff._x000D_ _x000D_ The study has four key parts:_x000D_ 1. What is already known?_x000D_ We will conduct a rapid evidence assessment to find research that has already been done on this topic. This will allow us to understand the range of approaches used to promote the use of internet-based services, and how effective they are. _x000D_ 2. What ways are currently being used in GP Surgeries to promote the use of and support internet-based services? _x000D_ We will use surveys to ask GP Surgeries about the type of internet-based services they offer to patients and how they encourage and enable both patients and staff to use these services. We will survey patients regarding their experience of digital facilitation_x000D_ 3. How do different approaches work in practice?_x000D_ Using the results from the practice survey, we will approach a number of GP Surgeries already using various approaches to promoting the use of internet-based services. Researchers will observe how these approaches work, as well as undertaking interviews with patients and staff to help understand potential benefits and challenges associated with different approaches being used to promote internet-based services. _x000D_ 4. We will bring our research findings together, and use the resulting information to develop a framework to help guide future related research. _x000D_ _x000D_ Four patients with experience of using internet-based services were involved in the development of this application. One co-applicant is a member of the PenCLAHRC Patient Involvement Group and will act as a patient and public involvement representative on the research team. Aonther co-applicant is a patient/carer representative with lived experience. We will work with a patient advisory group at key points throughout the project. _x000D_ _x000D_ This study will help to inform future research into how effective certain approaches might be and whether their effects outweigh the associated costs. We will also publish the results of this study widely in scientific journals and other publications accessible to staff and patients. We will work with GP Surgery staff and patients to ensure all appropriate networks are aware of the results and that the outcomes are disseminated in an accessible way, including the development of a project website and a stakeholder dissemination event in London.

Lay abstract: Background_x000D_ Recent years have seen a push towards the adoption of online services in primary care, ranging from booking appointments and ordering repeat prescriptions, through to the use of email and video consultations with patients. Around a quarter of patients are now registered to use online primary care services such as booking appointments, ordering repeat prescriptions, and viewing their own records. Online services have the potential to reduce administrative burden, improve communication, and improve access. However, to realise these benefits, patients must be able to, and wish to, make use of online services; there is the danger that these initiatives may increase inequalities in access to health care for some patient groups. One potential way to support the use of online services, which we address in this application, is through ‘digital facilitation’. This is ‘that range of processes, procedures, and personnel which seeks to support NHS patients in their uptake and use of online services.’ _x000D_ _x000D_ Aims and objectives_x000D_ We aim to identify, characterise, and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice in four areas of England, and to design a framework for future evaluations of the effectiveness and cost-effectiveness of such interventions. We will examine the different models of digital facilitation that exist, establishing the evidence base behind them, and exploring their current use in English primary care. Further, we will examine the potential benefits and challenges associated with different models of digital facilitation from the perspective of practice staff, patients, carers, and other stakeholders._x000D_ _x000D_ Methods_x000D_ A mixed methods approach will be employed consisting of four interlinked work packages. 1) A scoping review will characterise the different approaches to digital facilitation and establish the current evidence base about the effectiveness and cost-effectiveness of different approaches to digital facilitation. 2) A survey of 500 practices, and analysis of the responses, linking to data from the national GP Patient survey, and to findings of a patient survey in participating practices. 3) qualitative research exploring the potential benefits and challenges associated with different models of digital facilitation, comprising of focused ethnographic case studies in general practice and interviews with stakeholders. 4) A synthesis of learning from workpackages 1-3 and development of a framework to inform future evaluations. Patients and the public will be involved throughout._x000D_ _x000D_ Timelines_x000D_ This is a 25-month study. WP1 will run from months 1 to 9, WP2 from months 6 to 17, WP3 from months 9 to 23 and WP4 from months 21 to 25._x000D_ _x000D_ Anticipated impact and dissemination_x000D_ Our dissemination strategy will be focused on informing NHS patients and carers, policy makers and frontline staff about the current status of digital facilitation, including potential related barriers and benefits. In addition to academic publications we will present our findings at relevant academic, service, and policy conferences, and engage directly with decision-makers and patients through targeted dissemination of a brief research summary. This will be facilitated through the development of a project website to support service providers in the use of digital facilitation, and a stakeholder dissemination event held in London.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE