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Thursday 27 October 2016
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Online access

The phones aren’t ringing as much as they used to and it’s all because of the drive for general practice to go online. Where is NHS England with Patient Online now and what are the plans for the future?

Patient Online is an NHS England programme designed to support practices to offer and promote online services to patients who wish to use them (booking of appointments, ordering of repeat prescriptions and viewing of the GP record).
In 2015, patients who used these online services booked 10 million appointments and ordered 15 million repeat prescriptions. Practices using Patient Online services notice that patient satisfaction goes up as patients become in charge of their own healthcare. At the same time, practice staff report they spend less time on the phone and on routine admin tasks.
In a digital age, it’s NHS England’s ambition to make the most of new technology to help people manage their health and care.
The Patient Online programme was launched in January 2014, to help practices deliver the Government’s digital expectations. By March 2016 everyone who can will be able to get online access to detailed information in their own health records held by their GP.
Since April 2015, everyone has been able to book GP appointments and order repeat prescriptions online, so it is now time to drive uptake of these services to patients in order to maximise the benefits of this digital technology across primary care.

The results
At first, the programme was met with some doubts from practices. But by the end of March 2015, 98.7% of all the practices in England were offering online appointment booking, with 8.5 million patients signed up for this service. Similarly, 97.4% of the practices were offering online ordering of repeat prescriptions, with 8.3 million patients signed up for this service. Ninety seven per cent of practices were offering online access to summary information in patients’ GP records. This enables patients to see any allergies and adverse reactions recorded for them and view a list of their current medications. So far, 2.9 million patients are signed up for access to summary information.
 Lynne Jones, practice manager at the Cropredy Surgery in Banbury, Oxfordshire says: “We have been offering these services to patients for years and increasing numbers are using them. Even those patients who don’t use them still benefit from fewer people calling the practice and staff having more time to help them.”
Practices are already reporting timesavings through reduced phone calls to receptionists and on administrative time while processing repeat prescriptions. Practices are also experiencing lower levels of did not attend (DNAs) for appointments booked online compared with those arranged on the phone or at the practice. The DNA figures were 2.3% for those booked online and 4.0% for those booked over the phone or in person in August/September 2015.
So far so good, but this is only the beginning of the journey towards a new digital age in healthcare. Dr Richard Fitton, a retired GP, ex-Caldicott Guardian in Tameside and Glossop and pioneer of GP online services commented in 2003: “Patients and information are the two most underused resources in healthcare.” The Patient Online programme is addressing just this by providing patients with the tools and support they need to make their care more convenient and efficient, understand their own health better, and take more control to ultimately achieve better outcomes.

Detailed coded record information
The 2015/16 GMS/PMS regulations state that by the 31 March 2016, practices need to offer coded information in records, to those patients who request it.
Coded information includes items such as problems and diagnoses, procedures, test results, with codes showing test results and whether letters have been received from the hospital. All GP system suppliers are currently undergoing updates to enable this change.
The Patient Online programme has released new guidance, Patient Online: offering patient access to detailed online records (see Resources), with support and examples to help practices offer their patients access to online detailed records. In 2015 patients viewed their test results more than 329,000 times, and letters about their care over 316,000 times.
Some practices have been offering access to full records for years, including comments related to test results and consultation notes. At
the moment, the numbers of practices doing this are low (currently 5% of practices), but they are rising steadily.
Practices have already reported benefits such as reduced time taken in annual review appointments due to patients being better informed and prepared.
 Full access can help to transform the relationship between the patient and clinicians to a partnership of trust.
The Patient Online team recently visited Street Lane Practice in Leeds where 600 of its 13,500 patients have access to their full GP online record.
Staff and patients talk about the benefits of record access in the NHS England video Patient Online benefits of online access to records for GP practices and patient - short edit (see Resources) and report Patient Online: Benefits of Online Access to Records Case Study (see Resources).
Patient Online survey

A recent survey carried out in November 2015 with a representative sample of about 1,300 adults aged over 16 (carried out by an independent agency on behalf of NHS England), reported the following:
l 55% of the respondents would like to book appointments online.
l  44% of the respondents would like to order repeat prescriptions online (lower number likely to be because not all patients that have appointment bookings will need to order repeat prescriptions).
l 23% of the respondents would like to view information from their GP records (a minority of patients are generally interested in access to their records but these are groups typically with long-term or complex conditions).
In terms of awareness of Patient Online, 51% of respondents confirmed they had not heard about online services in practices.
There still is work to do to spread the word nationally about Patient Online services and also to provide support in terms of consistent messages and benefits to local practices.
The same survey indicated that patients are most likely to respond to encouragement from their GP practice to use online services, emphasising the strong relationship between patients and their GP.

Support to practices and patients
The Patient Online programme has concentrated on supporting GP practices in their implementation efforts by developing and publishing guidance, such as the newly released and updated Patient Online Support and Resources (see Resources).
This interactive document includes guidance and practical tools for practices, links to Royal College of GPs’ guides, information leaflets and promotional materials for patients, frequently asked questions and case studies.
It offers clarification of pertinent issues such as proxy access and safeguarding, too.
The programme also offers local support from a team of experienced change facilitators and digital clinical champions (practicing clinicians).
In order to build on the achievements to date on Patient Online, we have made some key public commitments to achieve over the next four years. These include:
l 2016/17: Greater range of ‘apps’ available to patients with access to information in GP systems through ‘open interfaces’.
l 2018: Patients will have access to the detailed information in their health records covering primary, acute, community and mental health care. Patients will be able to ‘write into’ their clinical records. Fifteen per cent of patients will be using smartphones to access NHS services.
l 2020: Patients will have access to the information in their health and social care records. The NHS will be operating ‘paper free at the point of care’.
In terms of other areas of patient access to information, the NHS Choices website, launched in 2007, has the highest reputation for good quality health information. The site receives 50 million visits a month, has had 25 million visitors (people visit more than once) and reports 80% user satisfaction.
In order to extend our service offering to citizens and leverage the public appetite for information, our ambition is to have single online access point for health and care services.

Digital inclusion
Experiences and reports from the voluntary sector, partners and community groups indicate that health can act as a real trigger point for our ageing population to start accessing the internet for healthcare information.
We recognise that computers, tablets and smart phones are not a substitute for visiting or phoning the practice and other health services, and that many people do not have access to computers or online services.
To help address this, NHS England is working with the Tinder Foundation (not-for-profit social enterprise that supports thousands of community partners to be smarter in how they use digital technology) to deliver a national programme of training in digital skills and access to technology, aimed at people who might otherwise not be able to use services online.

Beverley Bryant, NHS England’s director of digital technology.

Patient Online benefits of online access to records for GP practices and patient - short edit
Patient Online: Benefits of Online Access to Records Case Study
Patient Online Support and Resources
Patient Online