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Tuesday 27 September 2016
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Social media in general practice

The widespread use of social media websites for both personal and professional use can have many risks and benefits to practices and their patients
by Anne Ward Platt

One of the great phenomena of the 21st century has been the explosion in internet usage and the development of social networking. Facebook, launched in 2004, now has some 900 million users worldwide, while Twitter's micro-blogging service has attracted over 250 million followers. Communication through social media offers unique opportunities for healthcare organisations to interact directly with patients, stakeholders and the wider public.

Have you considered the implications of social media
for your practice? The potential benefits include:

- Encouraging patient feedback in real time, allowing a speedy response to concerns or suggestions.
- Reaching hard-to-engage groups, including young people.
- Enabling patients to access self-help advice and appropriate support for chronic conditions.
- Consulting on existing services or proposed service redesign.
Promoting healthy lifestyle choices.

Carefully planning your social media strategy is key. You will need to think how it can support the existing goals for your practice, as well as create new ones. There are also resource implications; staff need sufficient expertise and time to maintain and monitor any social networking sites, for example a Facebook page, as well as ensuring that the practice is listening and responding to any feedback. You will also have to consider that:

- There may be confidentiality issues if patients divulge personal information.
- Legitimate criticism is to be expected, but you could also create a forum for unfounded or defamatory allegations about your services or staff.
- If you fail to monitor the site closely, inappropriate language or content could offend or deter other visitors to your site.

You may decide that your practice is best served by making use of existing portals for feedback and information. For example, you could enhance your conventional practice website to signpost patients to NHS Choices,¹ Patient Opinion² or iWantGreatCare³

as well as to social networking sites dedicated to supporting people with specific conditions or healthcare needs.
 
Your practice's involvement in social media could be an incremental process, giving you a chance to explore the methods of communication best suited to the groups you want to reach. Last year, Hillview Surgery in Middlesex started to use YouTube to host a series of videos covering a range of topics including information about the practice and the management of common health conditions. Now the practice runs a YouTube channel with 175 videos, with some playlists devoted to commentary and feedback from patients about their healthcare experiences.⁴

Any consideration of social networking by the practice should include a review of existing policies. This will allow you to revise and update them with regard to the specific issues relating to social networking by staff, in either a personal or professional capacity. Terms and conditions of employment may also need to be amended to cover the standards required both during and after work, and may apply to staff even when they have left the practice. It is also worth thinking about how you would respond if either the practice or its staff were targeted by malicious online behaviour.

You could develop a dedicated social media policy for the practice which could function as a useful training tool and provide an opportunity for consideration of the personal and professional advantages of social networks as well as the potential risks. Reference to the benefits of social networking for staff might include mention of sites such as doc2doc for doctors, NurChat for nurses, and those maintained by professional journals such as Management in Practice.⁵,⁶

People easily overlook the hazards of social networking and issues of concern that you could highlight to staff include:

- Tweeting without thinking about potential consequences.
- Inappropriate comments or contacts by current or former patients.
- Inadvertent breaches of confidentiality or data protection in relation to patients, colleagues or the practice.
- Libellous or defamatory statements.
- Over-reliance on privacy settings.
- The potential for identity theft.
- Damage to the individual's professional standing.
- Compromising the reputation of the practice.

Although the vast majority of healthcare staff use social networking responsibly, the more you can do to raise awareness of the potential risks, the greater the protection you will give to your staff as well as to your patients and the practice. This also extends to encouraging staff to highlight any concerns they may have about the way in which colleagues are bringing the practice into disrepute through thoughtless online comments, or by compromising their own professional standing.
 
The consequences of injudicious or deliberate acts on social media networks can be devastating, ranging from trivial indiscretions to criminal activity. Social networking incidents involving healthcare staff have included:

- Breaches of patient confidentiality, including photographs of patients taken without their consent.
- Abusive or inflammatory allegations about colleagues or healthcare organisations.
- Photographic evidence of breaches of infection control or health and safety procedures.

It is not surprising that the Nursing and Midwifery Council has seen a rise in the number of cases involving social networking being considered by its fitness to practice panels, while the General Medical Council is currently consulting on changes to Good Medical Practice to take into account such online activities. Existing guidance for doctors and nurses on using social media emphasises that their conduct in the 'virtual' world should be commensurate with the professional standards they are expected to uphold in the 'real' world, and this expectation could apply equally to all other practice staff. ¹⁰,¹¹

Social networking is a powerful tool for communication. Its potential in healthcare has yet to be fully realised. Raising awareness in your practice will enable you to meet the challenges and opportunities it presents.

References
1.    NHS Choices. www.nhs.uk
2.    Patient Opinion. www.patientopinion.org.uk
3.    I Want Great Care. www.iwantgreatcare.org
4.    Hillview Surgery, www.hillviewsurgery.nhs.uk, and its YouTube channel, www.youtube.com/user/hillviewsurgery
5.    doc2doc doctor's community. www.doc2doc.bmj.com
6.    NurChat. www.nurchat.blogspot.co.uk
7.    Anon. Doctors suspended after playing Facebook Lying Down Game. The Telegraph, 9 September 2009.
8.    Cuzner E. The hidden dangers of social networking. MDU Journal 2009;25:12-13.
9.    Public bodies in Norfolk and Suffolk discipline staff over social media comments. Eastern Daily Press, January 13 2012. Available at: www.edp24.co.uk/news/education/public_
bodies_in_norfolk_and_suffolk_discipline_staff_over_social_    media_comments_1_1168446
10.    Nursing and Midwifery Council. Social Networking Sites. Available at: www.nmc-uk.org/social-networking-advice
11.    British Medical Association. Using social media: practical and ethical guidance for doctors and medical students. London: British Medical Association; 2011.

Resources
1.    NHS Practice Management Network. Improving access, responding to patients: A 'how-to' guide for GP practices. Crown Copyright 2009. Section 7, Communication; Section 8, Patient Engagement.
2.    Department of Health Informatics Directorate. NHS information governance: Information Risk Management. Guidance: Social interaction – good practice.