Finances, procurement, reorganisations, research, and new models of care

We took part in our joint HSJ Awards - Best Consultancy Partnerships interview with one of our clients this week, as we come towards the end of a 3-year programme. As one of the original gang at Redmoor Health, it was nice for me to reflect on the successes of a strong relationship, developed to deliver a long, multi project programme aimed at increasing digital access, improving patient communications, upskilling the workforce and supporting the Digital First team to deliver their aims.   I took a moment to consider this strategic partnership against the current climate of change and chaos in Primary care and thought I’d share some musings with you. BTW, its 8mins long so get yourself a brew and ponder with me.

Finances

Its that’s time of year, when in the last quarter, there is traditionally a frenzy of activity in General Practice. Teams are chasing patients and are working hard to recoup any finances earned throughout the year to maximize payments, following delivery through QOF and the Primary Care Network contract.  With only 7 weeks to go to the new financial year, uncertainty over pay and contract negotiations is making next year’s planning harder than usual.

Throughout 2023, there was a raft of new guidance, contract and service changes that managers needed to understand.  ICBs and Regions are now comparing progress against targets and seeking assurance or evidence of improvements against new criteria before they can release payments. Some are excelling at this, others finding it hard work. That’s on top of the usual round of ‘heck, we have to spend this money before year end’ last minute decisions. Previously, we’d agree with our clients to receive and hold this year’s £s, then together work up a more detailed scope for delivery into the new financial year, when their priorities are a bit clearer and they can engage properly when primary care have more time.  With the reorganisation and requirement for a 30% reduction in costs across NHS Regions and ICBs, some people are facing redundancy or moves to other jobs, consequentially, loss of local organisational knowledge and decision-making inertia is becoming clear.  Also, the combining of primary care transformation and digital budgets is affecting financial flows and prioritisation of projects.  Clawbacks on unspent budgets are being mentioned in dark corridors and on socials, which is a sad reflection both on the plans and especially when primary care need the funding right now. 

Primary care contracts

One element of the PCN contract is the capacity access and improvement payment.  Unsurprisingly (clue is in the name) this is largely about improving patients experience and access, with payments linked to improved appointment recording.   As part of our Digital Managed Service, our team have been supporting PCNs to deliver this guidance, contract changes and ‘new models of care’, so my super colleague Dillon Sykes and I thought this might be a topic for discussion at our session at Best Practice, London on 28 & 29th February.   We’ll explore some of the headlines, overlaps and gaps, ponder a little around the various checklists and criteria to be met, then hopefully share some practical steps to help.

We are seeing lots of angst that the General Practice Appointment Data (GPAD) dashboard still seems to contain inaccuracies and a lack of clarity over what is counted, and how to make historic changes etc that will impact on payments.  New to the ‘additional roles’ stables are the Digital &Transformation Leads and alongside PCN Managers, both are still trying to understand appointment mapping guidance released in 2021.  Clinical system providers have released workarounds in the last couple of months as temporary fixes. Frustrations are appearing between General Practice and PCNs as the data is held and configured at practice level, but the impact is felt in the PCN.

It’s great to hear that some ICBs are supporting well, providing datasets throughout the year to keep an eye on progress.  We are sincerely hoping that ICBs take a pragmatic approach to releasing the final 30% payment, whilst the data is still ‘more than a bit flaky’ (technical term).

To help with GPAD, our team ran webinars and held 1-1 sessions with practices or new D&T Leads to go through their configuration and data. We produced a simple GPAD tool to help navigate the guidance and we’ve also asked passed on quite a few questions to people in NHSD/E to gain clarity.

Procurement of new digital solutions

This last year’s quarter is also a little bit different though, for many suppliers of services and products to the NHS. It’s not unusual for slippage in the NHS, but some of the key elements of the Delivery plan for recovering access to primary care that slipped or were reprioritised, will have knock-on consequences for many colleagues in the product and supplier landscape.  This will also affect practice teams and inevitably, on patient services.

Many commissioners were getting ready to re-procure their digital tools to support Modern General Practice Model, but the Digital Pathways Framework on the Digital Care Solutions buying catalogue due in Aug 23, then moved to Dec 23, still isn’t released for commissioners to purchase from. 

I’m fortunate to occasionally take part in user research and know the NHS team are working hard to make the experience of the buying catalogue better, but this delay has impacted on ICBs, PCNs, Practices, Product suppliers and support organisations like Redmoor.  Part of my job is to seek out new partnerships and products that will help to improve General Practice, and I love chatting with new suppliers to find out how their solution will help.  There are a few with products that will knock your socks off but are not available to purchase from the existing procurement frameworks. Some PCNs are bravely buying directly, as they can already see the value, but many are nervous or don’t have the finances to buy direct, especially if their local ICB is expected to and will fund (or even part fund), once the new buying catalogue is available.

As a consequence of the delay, it looks like many commissioners have little choice but to extend existing digital solution contracts for another year. This can leave practices with products that they didn’t choose or don’t use and patients don’t like to use, so stick with the conventional methods of access (Telephone).  So, in ‘kicking the can down the road’, existing suppliers breathe a sigh of relief and new products don’t get into the market, leaving us all feeling just a little bit frustrated at what might have been for another year.  Do we invest time and energy trying to optimise solutions that we know don’t fit the needs of our staff and patients?

Our new procurement support service logo

Suppliers tell me they have lots of interest from ICBs and PCNs but can’t recruit to scale up delivery until they know the contracts have landed.  There will be a rush at the end, and we know deployment and implementation will suffer. These tools are essential to deliver high quality 21st century primary care. Having been through this process with one of our strategic clients last year, we have experience and are well positioned to support suppliers and ICBs with market and practice engagement, early implementation, adoption and spread. So, if you want to plan early, drop us a line and we’ll walk you through how we can help.

An example PCN dashboard showing the costs and variation of products in use.

Research

In addition to user research for products, I also contribute to research for new services in development and I’m delighted that NHS are developing a guide to improving messaging. This has become such a complex area, since the inclusion of messaging as a requirement for all online consulting tools. The NHS is paying twice for quite a few functionalities and the holy grail for practices was always to have digital solutions in just one platform. There are a couple of suppliers doing this extremely well, and with the increasing desire to reduce SMS costs, data messaging is the way forward for many. One super research project that I’ve had a small involvement as part of their Expert Advisory Group is the Remote by Default project from the teams at University of Oxford and Nuffield Department of Primary Care Health Sciences. They’ve released some great resources following a 2 year study into remote care. We’ll be helping to push these out to patients in over 700 practices via our Social Media managed service, and will build the training competencies into our programmes, so we are confident that our work is grounded in rich research. What is interesting, is the different approaches across the Nations. Scotland have procured one video consulting platform for the whole nation to use, with a contract to 2026. This means they have one set of patient facing resources and one training platform for all practices and users. Very different to our market place approach in England and probably a lot less confusing.

Now – lets’ talk telephones

As another example of what I’ve just described in the procurement section, lets have a look at the requirement for Advanced Cloud Based Telephony.  Seen by some as the panacea to ‘the 8am rush’ and made a requirement in the GP Contract by end of 2025.  The Better Purchasing Framework was issued, some ICBs took advice and started to plan the ‘at scale approach’, working out whole system requirements, engaging with practices and PCNs to gain advantages of greater purchasing power, optimise local infrastructure and achieve some consistency of service offer – great stuff!   Then a letter appeared late Nov, expecting all practices to sign up by 15th Dec 2023 or they would miss out on the funding opportunity.  Thankfully, someone realised the well-earned Christmas and New Year holiday was looming and the deadline to select a supplier was moved to 15 January 2024, with a signed contract by 2 February 2024 and go-live by 25 March 2024, with all features in place by April 2024 at the latest.  Just another added pressure in the last quarter of the year.

Now there is anxiety over where the costs will land, and we had a flurry of requests to help people make a choice urgently, so they didn’t lose out on funding.  We had others that had already moved to cloud telephony before the contract requirement was released, but had chosen suppliers not on the framework, so maybe didn’t have all the features mandated in the new contract.  Some practices had been earlier adopters, made the investment then found that there was support to buy out of existing analogue contracts.  Or course, anyone that has ever implemented new technology knows you can’t do it in a rush without good planning. Then after deployment comes the real fun – how to make it work for you.  We saw this happen during the pandemic with the necessary but rushed roll out of online consultations.

Our team have been delivering workshops, listening to and improving auto attendant messages, optimising call flows, aligning with online service options, all to ensure fair access to services and an improved experience for patients. And then of course we threw in a Digital Journey Planner module around planning and optimising Telephony.

Example Call Flow options with routing out to alternative and online services

This is just a flavour of our support on offer to help the NHS at all levels in primary care to navigate the noise, help with the priorities, support the providers to deliver, optimising the solutions available.  We hope you can come and see us at Best Practice at the end of the month, we’ll be at Stand D45 talking all things primary care improvement.

Book here: https://ow.ly/Tf6050Qz6sE

If you cant make it, drop me a line or get in touch hello@redmoorhealth.co.uk because we love to help and know a bit about your world right now.

NHS App Redesign – an essential part of your ‘digital front door’ 

At Redmoor Health, we’ve been helping practice teams, the wider NHS and communities to support patients to ‘get online’ to access health services for several years now.  We have also been out and about this year at various events asking the question, ‘Does your digital front door revolve?’.  

Home slide, showing Cogs including the words Access, Experience, Demand, Capacity and Capability. Title 'Does your digital front door revolve?' - A Reality Check
Slide from Presentation at Best Practice Event, Birmingham – ‘Does your digital front door revolve?’

We ask this question in relation to the experience of patients who report their online user journey as ‘going around in circles’.  Similarly, as providers in healthcare, the NHS has access to a myriad of digital products, not always well designed or interconnected, that occasionally send people shooting off in directions they weren’t expecting or losing them on the way to finding help.  Primary care staff often ask us for help to understand all the features across different software and systems and how to get the best out of them together. 

So, I’m delighted to see the announcement that the NHS App is being redesigned, following extensive user research to improve that journey and to become the essential part of the digital front door, along with good websites, making entry into NHS care easier.  

images of Welcome screen and Messages screen for new NHS App design, with labels to show users what the changes will look like
Slide showing images of Welcome screen and Messages screen for new NHS App design, with labels to show users what the changes will look like

From 12th Dec, NHS App users will be prompted to update their App and will start to see some changes, making things simpler to navigate, with clearer language and a more intuitive experience – wonderful stuff! 

The NHS set a target of 75% of the adult population in England to be registered to use the NHS App and NHS website by March 2024.  That’s a big ambition, especially with over 10m of the population still lacking the most basic digital skills, according to Good Things Foundation Digital Nation UK 2023.  It’s also not so easy to ask patients to move from another App that they have used successfully for several years, to something new when they can’t see any additional benefit.   

We thought we would offer you some help along the way to achieve this target. You might consider this a late Black Friday, a Cyber Monday or even an early January Sale deal from the team at Redmoor Health. 

In Jan, we will host a couple of free webinars not only to walk you through the changes, describing the additional benefits, not just for patients but for practice staff too, in terms of time saved and an easier workflow.   

For anyone still wondering what to do for their QOF (quality outcomes framework) quality improvement project in practice or PCN (primary care network), we have a simple action plan to help you to increase the numbers of patients who order their medication online.  

image of front page of the quality improvement plan to increase NHS App usage, linked to Digital journey planner, with smart goals for improvement
The quality improvement plan to increase NHS App usage, linked to Digital journey planner, with smart goals for improvement

We can help you to to find your data as a baseline, so you can show the improvement and help to secure your 30% funding against the capacity access and improvement plans. 

Polite plea to the NHS App data people – how about providing the data out in the open, instead of behind this dashboard and let us help you to share it widely through our digital maturity index. If you are curious, have a quick look at this explanatory DMI video, where we have just added NHS App as a separate dataset, helping practices to see all of their available ‘online data’ in one place.   

image of PowerBI Digital maturity index dashboard showing NHS App data
Digital maturity index dashboard, containing various online datasets, including NHS App
Image showing social media post about managing notifications in the NHS App

In addition to the content provided in templated scripts for websites, socials, messages and telephone, we can also help to maximise awareness and engagement with a full suite of social media posts ready to release over the coming months.  If you don’t have the time to post, or don’t feel confident in using social media, we can offer you support to do this via our social media managed service. Over 650 practices have chosen this option and if you’d like to see some reviews before you decide, head over to Practice Index. 

Don’t worry if you miss the NHS App webinar on 19th Dec, (we know you are very busy in the run up to the holiday period) you can attend one of our two webinars in Jan 2024.  Simply book your place here for 11th Jan 2024, 12 o’clock, or 30th Jan 2024, 12 o’clock.   

image of social media post for ordering prescriptions in NHS App

If you book to join us, we’ll give you the discount code for the social media managed service so you can have 12 months for the price of 9 months at £349 for the year.  That’s the equivalent of ½ day locum fee, or 1 week of admin time for a full year service.  What’s not to like!   

Looking forward to seeing the effects of this as a campaign to support General Practice.  If you’d like to join us, get in touch hello@redmoorhealth.co.uk

It’s not just about the data, it’s how we know where to look for the patterns.

A couple of years ago, a client came to us for help to understand the ‘digital maturity of their practices and PCNs’, asking us which indicators we would use to measure a baseline and monitor improvements, and then take practices through different levels of maturity.  What a lovely question – we had a ponder in the team.

What was the problem they were trying to solve?

Well,

  • They knew they could access various digital data sets, but they couldn’t see a way to compare across practices, within PCNs, Boroughs or across the ICB.
  • They had to look in lots of different places to find data but couldn’t decide which elements would help.
  • Some data was open source but updated annually or with a time delay in release, so aligning and getting a baseline was challenging.
  • Some data didn’t seem to be relevant, but they weren’t sure if it was or not because they weren’t close enough to the service delivery to know if and how it helped.
  • Other data was behind barriers to access; usernames, logins, assigned to specific roles, and some data was provided to them directly by system suppliers.
  • They had programmes to deliver; online and video consulting, improve GP websites, advanced telephony.
  • They wanted to help their practices to mature, but didn’t know what ‘mature’ looked like.
  • They wanted to use data to underpin and evidence any improvement.

No small ask. My biggest fear was that anything we provided would be used to ‘performance manage’ practices who might appear at the ‘lower end of any scale’, without any understanding the complexity of primary care and running the risk of focussing on one dataset, in isolation of the others.

I’ve been on the receiving end of a ‘Red, Amber, Green rating’, and been given stretch targets in previous roles. Benchmarking can be a challenge and cause unintended consequences, if not communicated and managed well. It can be tough when working in one of the ‘top performing’ practices, then being compared against others who were given much less to ‘achieve’.  I was very keen to stress that, yes, we could offer help, but the data we collated would come with a health warning about its purpose and use.

Roll on 2 years…..

We have moved through a process of days of data mining and cleansing via databases and working with multiple spreadsheet and worksheet merges.  We’ve had people try and make it an easier process. We’ve seen the NHS develop further data sets and stop supplying some that were useful. We binned the idea of ‘levels of maturity’ as the improvements can fluctuate and its soul destroying to drop a level when working flat out. We have moved on to think more about how we visualise the baseline and show progress, whilst trying to make it as user friendly as possible, and finally, with the super team at Primary Care Analytics, ‘we’ve built a thing’ that people seem to be enthused by.

How Redmoor Health add value

This is the real gem for me.  It’s not just about looking at the numbers, trends, or patterns, it’s about understanding the environment, each activity and then connecting the various datasets to tell the story for the people who are currently so overwhelmed with data and requests for how they can use it, they cannot see beyond the spreadsheets. We’ve had this experience this last few weeks, as a number of our clients are submitting their capacity and access improvement plans. Seeing the ICB variability of requests for plans, some helpfully pre-populated, others just big horrible spreadsheets, makes me weep.

Our team of primary care specialists can quickly look at the various elements in the Digital Maturity Index (DMI for short – because we love a three-letter acronym in the NHS) and walk you through:

How many people are enabled for Online Services? Average of 49% nationally

How many people are using online services each month? Average of 1.3% nationally for appointments.

How many people can order their medication online, then how many are doing this? Average of 49% are enabled, but only 12% ordering each month, in some areas its less than 1%. 

The missed opportunity suddenly jumps out! 

Many patients are keen to do things online, they understand how to do this, and want to help their practices by self serving. Some may have the NHS App, downloaded during Covid but are not utilising it to do even the most basic of transactions.  Some have had a poor experience and dont use again. So, we can dig and ask why.  It’s easy to spot those practices who aren’t offering online appointment booking and cancelling – but we take this a step further.  We offer help with searches so they can see who has booked into the wrong slot – Yes, we all know about the patient who has booked their Asthma review online, but they’ve booked into a ‘smear’ slot.  Practices may also be using a system that doesn’t feed into the ‘patient online’ data, that doesn’t mean they aren’t offering online booking.  We coach and support ICBs to understand and check this, before making assumptions about performance.

We also help practices and PCNs to see where they may be creating some of their own demand and advise how to reduce this. 

From a patient experience lens, we can view Friends and Family test data and GP Patient Survey data. We can look to compare patient experience and see the Telephony demand, lo and behold, 84% of calls are about appointments. We’ve already established that utilisation is low, compared to the patients ability to do this. We know how to help avoid the 8am rush and its not just about having cloud based telephony, its about call flow design, relationships with online services and good signposting to alternatives.

We have included electronic prescribing and repeat dispensing data, then we can compare pharmacy nomination and repeat dispensing to check that practices are taking advantage of these options to reduce workload demand.

We can look at the question: ‘how easy did the patient find the GP website to use’.  If the website hasn’t got the right information about how to do things, it’s not a surprise that telephone demand is high. We can even see which services were used when the practice is closed, with 57% using NHS 111 nationally.

Already some of our clients are asking for extra data sets to be included, so we’ve added the Register with a GP Surgery data and the GP2GP data too.

Finally, we can look at how the practices in each PCN compare on a map and see patient satisfaction across a range of 8 questions, not just the 4 recommended in the latest Capacity and Access improvement plan requirements.

Not only does the DMI help us and our clients to see the opportunity, but it is also helps us to see the improvement of the practices using the Digital Journey Planner, our step by step coaching and knowledge system in use in over 1300 practices in England. 

We are delighted to announce our Partnership with Conor Price and the team at Primary Care Analytics to use primary care data to inform our work and see where we can offer help. 

If you’d like a walk through, please do get in touch hello@redmoorhealth.co.uk

Reflections of #CampDigital, through the lens of the NHS

I’ve a couple of blogs whirling around my mind now, and knowing what to say and when to say it is often the thing that stops them from moving from my brain onto the paper (well virtual paper).  I’m also a little unsure who would want to read too, but Coach Sharon says, ‘just put it out there and see what reaction you get’.

This week started off a bit challenging, as well as my main job at Redmoor Health, I still work in General Practice, and I was onsite at the surgery for the day.  I had 3 tasks that have been niggling for a while, but I found each one so convoluted, I didn’t fully complete any of them.  I was despondent and also fully understanding of why change in the NHS is flipping hard and takes time.  So, I’ve decided to work backwards in sharing this week, as it most definitely ended on a high. 

I’ve been lucky to go to Camp Digital for the last few years, hosted by Nexer Digital and as ever the speakers and people who attend inspire, uplift and confirm my hope that the start of my week’s challenges can be resolved with the right approach. There is a community of wonderful people, passionate about making things better, focussed on user research and digital transformation truly grounded in data, design, and experience. I hope some of them move into or stay in the NHS and not leave it, I hope others move to product suppliers and service design to build things better from the start. I also hope they have the opportunity and confidence to speak up and say, ‘this is too early to ship to market, we have more work to do’.

Having been in the workplace for 40 years this month, ‘improving’ is as much in my nature as is ‘sharing’.  Work started for me in the nuclear industry with Quality Control, then Quality Assurance in 1983 and 1991, moving into the NHS 20 years ago with a stint in Service Improvement, then Commissioning and provision in General Practice. So James Plunkett’s keynote session was easy to relate to.  James weaved his story of ‘history rhyming rather than repeating’ through the opportunity for scaling up and consistency, via Ford’s mass production, to making beautiful artisan loafs into the mass produced, square, white stodgy thing that many may think of as bread today.  James absolutely recognised and rubber stamped the mantra that digital transformation is ‘all about the people and ways of working’, not just the tech. This is one of my favourite T-shirt slogans.  Watching the NHS attempting to scale up, deliver consistency and increasing its awareness of quality improvement right now, feels like we are at a junction where we can go down the path of mass production, using methodologies and run charts, or, we can pause, and have QI in our minds as we ask curious questions to understand ‘what is the problem we are trying to solve?’, who’s involved, what are the issues, and then assess which approach can help.  I’m minded to use the term ‘optimise’ a little less often now though James, but I loved this slide.

Slide saying No, I will not build you an app hub thing with AI, 'app' and 'hub' are both strikethrough text
James presenting in front of his slide that is saying No, I will not build you an app hub thing with AI, ‘app’ and ‘hub ‘are both strikethrough text

In the second keynote, Shabira Papain of People Street, shared her fun, obvious passion, and practical advice to explore social justice, and design for the 20% who are most likely to be digitally excluded. The NHS catchily refer to elements of this as Core20PLUS5.

Sketchnote by @ChrisSpalton

Sketchnote of Shabira's session from Chris Spalton

As public sector workers, we were challenged with the moral obligation to design for those who are excluded and not just to ‘open doors’ but to ‘invite people in’.  This reminded me of earlier in the week, as I had just added ‘Register with a GP Surgery’ to our practice website, to help new patients register online instead of having to come into the practice and fill in a form (currently comprising 12 sides of A4 paper).  Then our practice manager instinctively went a step further, got an iPad out of the cupboard (that’s another story), loaded up the site and showed the Receptionists how to help people who may be excluded from this new process, either because they don’t have devices, data or confidence to do this.  Now, someone in the team can sit with people who need help to fill it in, rather than just signposting to the website.  I didn’t need to mention ‘digital inclusion’ to her, even though it’s just one of the many priorities in the NHS. She knows her patients and how many of them still walk in for help and quickly offered an alternative support option. That is inviting them in, yes?

Older Adults: Are we really designing for our future selves?’

Next up, in a change of order, I decided on Elizabeth Buie’s talk ‘Older Adults: Are we really designing for our future selves?’

I’m (just) entering the category of ‘older people’, although as Elizabeth described, even agreement of who is old, offers variation in studies.  I like to think I’m on the younger end of old. Wonderful, personal insights brought this session to life, with a bit of audience participation on who could hear (or not) the audio files linking age to changes in hearing capability.  The best bit for me was understanding the difference between ‘fluid and crystallised intelligence’ as our ability to remember, learn and process may slow down, yet our knowledge from experience and education remains throughout life. I hear the term ‘subject matter expert’ often in the NHS and I’m sometimes asked in our team, to coach and pass on knowledge to our newer, younger colleagues.  I also get to guide NHS commissioners on how to ‘deliver their priorities’ with general practice. But sharing 40 years of work in change, quality and improvement then knowing which bits are relevant, when to offer and who to, can’t quite be distilled onto an A4 product sheet, or a simple checklist.  It’s much more nuanced. I know that the stuff I have experienced comes at random from my memory bank, whist I can forget in 5 mins what I’ve just been present in. Thank you, Elizabeth, for taking me back to the clicking keys of the typewriter and explaining why the ‘qwerty’ keyboard originated because the keys stuck on the most frequently used letters.  Even though I know the order of an alphabet, car parking payment machines ordered by alphabet not qwerty, can raise my blood pressure! 

Car Park Payment machine, lots of different features for people to press, numbers to telephone and ways to pay

Linking this to the workplace where we have the possibility to use voice to text software, yet we are still advocating training in touch typing for clinicians, seems like a missed opportunity.  Thinking about dexterity, knowledge, and experience, then watching GPs who may have trained 30 years ago to quickly scan-read discharge letters for key pieces of information, seeing them struggle to navigate this same information in a variety of formats on multiple screens, seems a punishment we should address as a priority.  Especially, if we are to improve the user experience of corresponding between healthcare providers. Watching people then retype (with errors) a summary of that information into another clinical system, slowly with two or three fingers is heart breaking, when many have used voice/dictation systems for years for their own letters, and the sending consultant in the hospital probably did the same.  Even considering when a consultation is being spoken between patient and practitioner, then typed up rather than recorded as audio, or converted to data and narrative to meet the needs of data transfer, task allocation and patient information. There is a research project here for sure.

The afternoon sessions did not disappoint either.  Audree Fletcher’s ‘Designing in the dark’ gave me many notes to take home, but this one message was a big one. A potential customer has to see a message 7 times before they’ll be provoked to action.

Audree reminded us that winning the big goals takes time, and finding the ways to achieve this is a lot more complex than just pitching your idea and hoping for the best.  As someone who can get disheartened when others don’t just come with me, the hints and tips and final canvas gave practical suggestions to help.  Understanding what else is going on in other peoples’ worlds, knowing the competition for funds, connecting the proposition to ‘what matters to them’, finding the right channels to drip feed the message, are all great ideas to get pitch over the line. I have loads of ideas how to make things better, then get dejected when they disappear into a dark NHS hole and layers of ‘commissioning by committee’. Meanwhile we lose months of progress whilst people ponder the relative value of this proposal over another. The NHS is amid yet another reorganisation, and many decision makers are involved in their own personal worlds of survival right now.  Yes, I need to put myself in their shoes, but maybe it’s ok to also bring them out into the shoes of the people that they are supposed to be commissioning services for.

Using existing data replicates bias. Q: In the sentence, "The professor told the graduate student she wasn't working hard enough", who wasn't working hard enough? A: The pronoun 'she' refers to the graduate student. Therefore the graduate student is the one who the professor believed wasn't working hard enough Q: In the sentence, "The professor told the graduate student he wasn't working hard enough", who wasn't working hard enough? A: The pronoun 'he' refers to the professor. Therefore the sentence implies that the professor was not working hard enough, according to his own assessment courtesy of @mmitchell_ai

Example of using ChatGPT to explore bias associated in existing data, see the affects of pronouns he/she to same question, about who is working hard enough. @mmitchell_ai

Sarah Knowles and Lynn Laidlaw’s discussions of Data Feminism and challenging power along with where the patient sits in all this change, got a big thumbs up. As a sociologist, this talk touched my heart. Hearing Lynn question the ‘burden’ of healthcare and why it is considered as ‘work’ for practitioners but somehow described differently for patients, reminded me to challenge people with power, to acknowledge their privilege and share it out a bit more.  Who has the power in the room should always be on our minds and it was great to see some familiar quotes and the effects of binaries, hierarchy and bias in our work.

The final keynote did not disappoint as data visualisation specialist Nadiah Bremer took us through constellations of data to rethink how we see connections. In amongst other more significant stuff, Nadiah represented the connections of google searches about cats and dogs in a beautiful way. 

I’m watching some parts of the NHS gets it knickers in big knots over data right now, with an unhealthy focus on counting the wrong things and making erroneous connections.  One attendee astutely observed that this final session, joined the dots across everything throughout the day together; research, experience, emotion, inclusion, context, power and data.  Powerful stuff.

And so back to my earlier part of the week, I’ve managed to resolve some of the problems, but it still feels like I’m wading through treacle. I now better understand my new cloud hosted, telephone system call flow design, following a further phone call to the supplier.  More edits are required to simplify for the user but still provide me with a whole load of data to understand. 

My ‘Test patient’ for the NHS App, is no longer a Dummy patient, it’s a live Test patient in EMIS, even though I still can’t associate it with NHS App. 

My Friends and Family data is now successfully uploaded into the bean counting system so we no longer have a big red mark against the practice, even though it’s an extremely crude mechanism to measure patient’s experience and I now have the 2023 General Practice patient survey to review.

For the people I work with in the NHS, you see this data stuff – we have a bit of a plan for you….watch this space.

Two sisters smiling

And finally, although she may not realise it, I also get to take my sister to work.

#LettersHack – Rethinking patient correspondence

Sketchnotes from Lou Shackleton Digital Front door, Websites, social media, email, SMS, missed appointments, we need quality content that helps patients to know what to do next
Sketchnotes of the session from Lou Shackleton

I’m a little late to the party with this blog, and others have already shared their thoughts and enthusiasm about #LettersHack – Rethinking patient correspondence (Eventbrite link for details) held on 12 Oct 22. If you’re curious to know what others enjoyed about the day, check Twitter and LinkedIn using the #LettersHack tag.  Also, please do read the write up from Hilary Stephenson, MD, Nexer Digital, ‘Is there a Doctor in the room?

I wrote one of my first blog posts about improving patient communication and the opportunity to use digital solutions to improve patient experience in 2018, after a series of missed opportunities with appointments, cancellation, rebooking, transfers of information between health care providers, all which prompted me to share my experience.  Four years on, it appears from the many examples of where it goes wrong, there is more complexity than ever. 

#LettersHack planning started before the Covid19 pandemic, with a desire to improve letter content, so that users of health and care services would not miss vital healthcare appointments.  Good patient communications help people to understand what has happened, what to expect next and feel included in their healthcare journey.  As a result of the rapid expansion of remote modes of contact and service delivery, we extended the scope of the event to consider the multiple modes of communications now in use. 

Lisa Drake, describing some of the practice perspectives of communication and sharing examples of the challenges in general practice

My part in the day was to set the scene for some of that rapid change in General Practice, but most importantly to state from the start; people don’t set out to do this badly and are often blissfully unaware of the consequences of poor communication.  There are many constraints in the systems or software available to General Practice and this ‘stuff’ can make communicating it harder to do.

Many ‘internal thinking’ configuration choices were never envisaged to become visible externally to patients or other parts of healthcare.  Electronic patient records weren’t designed with patient visibility as a factor, and we are seeing this very challenge played out now with concerns and delays to the online records access programme.  I attempted to share some of these challenges; lack of time, poorly designed products, changes in regulation, societal norms and policy, and often, where the tech just hasn’t caught up.  I offered plenty of examples of unintended consequences where communication just doesn’t achieve its aim, may have caused frustration, confusion, or concern, or just wasted people’s time.

At Redmoor Health, we feel passionate about supporting General Practice and offer lots of help and advice to front line teams to deal with these daily challenges. It was lovely to work with the Nexer team on this event, bringing their inclusivity and service design thinking to our digital communications and change, training and support programmes and we look forward to further events together.

Lets Talk about Sex - Emma Parnell. sketchnotes by Danielle Stone

We all know the NHS is under extreme pressure, in fact someone commented in the session that ‘it’s broken’.  At the same time, many of us are patients and active citizens who want to get this right and help where we can.  There was definite sense in the room of ‘we can do this better’ without blame or criticism. In fact, Emma Parnell, Founder of Design for Joy, hit the nail on the head during her wonderful set, ‘Let’s talk about sex’ with the question, ‘How can we use our collective experience and influence to make a difference?’

Emma’s talk really drove home the absolute need for NHS services and systems to be inclusive, and the need also to question why we collect some data, along with how we do that in a way that makes people see themselves and feel comfortable accessing essential services. 

Emma Parnell describing the service design changes behind the NHS covid vaccination system to be more inclusive for trans community

Sarah Wilcox, Senior Content Designer, NHS Digital was equally inspiring, sharing her personal experience of less than effective communication (I’m being kind – the experience was rubbish) and walked us through the wonderful thing that is the NHS digital service manual, emphasising the importance of inclusive language to ensure broadest reach of the population, through the elements of the content style guide.

These were perfect examples of using our personal experiences to do something positive about it.  The mix of people in the room provided us with an opportunity to consider many perspectives. Some offered insight into the setting of standards; core content requirements, timeliness of delivery of information, items that should be communicated between hospital and GP.  Others, led strategic IT programs of delivery, such as covid vaccination invitations and vaccination recording.  There were people who designed and delivered products to support General Practice with websites, communication and messaging systems, applications to access transactional services to help people order prescriptions, book and cancelling appointments.  Most importantly, everyone felt aligned in their desire to improve the experience for users; and that’s people who both receive and deliver communications.

We chose to three main categories of communication to unpick;

  1. Broadcast – using social media and websites
  2. Targeted – using message systems to deliver public health campaigns
  3. Personalised – using individually tailored content, via messages, letters, or even phone calls.

The afternoon breakout sessions had plenty of examples of communication to scrutinise and rethink or rewrite.  Our group task was to consider ‘How do we use social media to maximise uptake of public health screening, whilst acknowledging the diverse communities we serve?’  We considered why people are nervous about some procedures, what they would want to know before attending, where we could find trusted information to back up short, impactful messages that reach the many different sections of the population.  Fascinating discussion was held on what is and isn’t humour and plenty of chuckles about references to cats and dogs – even the Kama Sutra and a need for a modern etiquette guide to reflect today’s diversity – genius.  We had rich, powerful, and engaging conversations that rarely happen over Teams meetings!  We also realised that these events don’t work well as hybrid, our sincere apologies to the people at home who only got to see torsos, rather than faces due to camera angle.

Amy with flip chart, post its, blutack, example sms content, suggested improvements

Social media has great potential to reach diverse communities and many surgeries now take advantage of our support with public health campaign messages.  Recognising time pressure, the Redmoor team help by creating content, administering pages, scheduling, and boosting posts to reach specific targeted audiences and have seen an increased reach and uptake of health screening as a result.  If you’d like to know a bit more, check our social media managed service information.

When it comes to websites, and integration with online services and consulting, we can also help NHS Teams and practices to smooth that patient or user journey, so that the practice and patients gets the best out of whatever system is available to them.  We’ve created digital journey planner to help staff to self assess their digital service delivery.   Three modules are already available to support good patient communication, GP online services and digital inclusion, with lots of learning materials to inform about websites, inclusive communications, effective use of messages etc.

Over the coming months, Nexer will continue to gather examples of patient communications, good and not so good on their airtable platform in the hope of creating good content library and guides in future sessions.  Iatro also have a commons library to share good website content for GP Practices.  Drop yours in via any of the social media platforms with #LettersHack tag and we’ll pick them up.

I can’t wait for the next session. Thank you to everyone who joined and made it so good.

PS Hilary did tell everyone we are sisters; I’d have let people guess….

Highly usable websites, inclusive and accessible content – all coming to a GP website near you

Well, this is very welcome…  

Future NHS page with the ‘creating a highly usable and accessible GP Website for patients’ guide, and ‘Patient-user research to support’

In the last few weeks there are some super updates to the guidance from NHS Digital and NHS England that will help GP practices to create inclusive content and usable websites. It should also make lives easier for people who need to use the ‘Digital front door’, aka GP practice websites. 

I’m talking about the updates to the NHS Digital service manual,  Content style guide and the ‘Creating a highly usable and accessible GP Website’ from NHS England’s user research team, Dominic Vallely and Emmy Graham. We’ll be exploring the content style guide and the ways in which practices communicate with patients in a joint event with Nexer Digital on the 12th October 22 (have a peek on Twitter at #LettersHack).

If you’ve followed my other GP website blogs ….

You’ll realise that I have a bit of thing for GP websites.  In my day job, I sit at the intersection between policy makers, NHS commissioners, specialists in inclusive and accessible research and service design, product suppliers and the people in practices who try and make sense of it all, to provide services to us as patients in the NHS.  It’s a nice place to sit.  I don’t need to be a specialist, I don’t need to have the technical know-how, and although I do know a fair bit about General Practice, service improvement and delivery, we all have experiences as patients that we can lean on and learn from. This guidance brings much of that knowledge into one place. 

This is why the guides are so helpful….   

GP Practices have a myriad of contract requirements to meet, in fact there are 10 pages of items listed in the ‘highly usable website guide’.  Many of them are iterations of earlier contract requirements, it’s no wonder practice teams are confused – I’m confused by much of it too.  The GP website supplier market is large, as is the online consultation market and each supplier clearly wants to do the best for their clients – the practices.  But occasionally and possibly due to the market competition, these suppliers sometimes focus a bit too much on their own branding and product and not quite enough on the usability of their product, either from a General Practice team perspective or the intended end user, i.e. the patient.  They may forget that their product needs to be connected to another NHS service and so needs to conform to the standards and style of the NHS brand, which is trusted and researched to reach as many people as possible.  Often, the user is confused when they access information online and get diverted off to a supplier’s platform, or suddenly the page no longer looks like their GP practice or even an NHS service. 

Home page from NHS Digital service manual showing the Standard for creating health content

Colours matter, language and content matters, the user’s journey matters, the technical layout matters.  For the practice teams who have a million other things to do, simple ‘how to’ instructions and examples help enormously and these guides offer sample layouts with ‘things to include’ and just as importantly, things ‘not to include and say’. 

Hilary Stephenson, Managing Director at Nexer Digital says,

‘It’s great to see the convergence of user centred design standards and technical platforms across the NHS and their vendor network. Sadly, in our work we have seen real issues with the core usability and accessibility of websites, consultation platforms and apps used for digital engagement. This feels like such a missed opportunity at a time where digital inclusion is vital for patients, their families and those delivering services under immense pressure. Anything that provides practical guidance, which is evidenced by user research and makes things more inclusive, from content design through to platform configuration, will improve the experience for patients, clinicians and administrative teams.’

Hilary Stephenson, Managing Director at Nexer Digital

Now the work starts….

There are over 6500 GP practices in England, just over 900 in Scotland, almost 400 in Wales and over 300 in Northern Ireland, each serving their average registered population of 9000 people.  That’s a lot of people to reach to reduce the variation of experience for users and for practice teams who provide information.  We have incorporated this guidance along with simple advice, hints and tips into an easy-to-use system called the Digital journey planner (DJP).  The first module; Patient Communications deals with Websites, Social Media and Messaging, The second module; GP Online Services covers everything that practice teams need to know to provide a good online service and make that easy for patients to use. If you are getting ready for patients having full online access to their medical records later this year, it’s a must. Our next module, due for release at end of Sept will be Digital Inclusion.

Map showing location of practices in England using the Digital Journey Planner. Blue dots have Foundation access, green dots are practices with Enhanced support from Redmoor Health to embed digital service delivery. Aug 2022.

So far 10% of practices are using this system in England currently and we aim for 25% before the end of the year.  At Redmoor Health we work with practice teams to help improve digital knowledge, skills, confidence and competence and offer support in terms of training, coaching, advice and share best practice resources that save practices time when searching for help.  These guides are essential learning tools to embed in the DJP, so they are easy to find and stand alongside practical hints and tips when to use.  Some areas have already commissioned Redmoor Health to carry out reviews across all their practice websites, just to get a feel for the scale of the problem and ideas how to help. Others have offered incentive schemes for practices to have the time and space to make the changes, so we anticipate this as a big opportunity to improve, standardise and simplify access to information.   

The suppliers…. 

Good suppliers have been using these standards for some time and have already created NHS style guided website templates, that meet the accessibility and usability needs of users and practice teams.  Others recognise that they need to encourage practices to move away from old legacy systems, personalised styles and ‘whizzy websites’ to be more consistent, and to simplify the user journey.  I’m quite sure many more will now take on these recommendations following the detailed patient user research that informed the guide. I spoke to a few to get their views of the research and guidance.

Iatro Practice 365 have already produced a simple version and template for practice teams to know what to add to their website. Thomas Porteus said,

‘We’ve been behind the NHS Service Design Toolkit since we started, it’s been a pleasure to work with NHS teams openly and to be able to contribute our own code back to the project for the good of all NHS organisations. The guidance is a really great point of reference for practices wondering where to start, and what to avoid’

Thomas Porteus, CEO and Founder of Iatro

Tim Green, co-founder of GPsurgery.net, commented:

“As advocates for patient-friendly, accessible websites since we began working with GP surgeries in 2004, we warmly welcome this new evidence-based guidance from the NHS Digital First Primary Care team. Clearly focused on simplifying the patient journey, the guidance offers practical advice and tips for practices and commissioners aiming to improve patient experience, reduce digital inequalities and remove barriers to access for patients with disabilities.“

Tim Green, co-founder of GPsurgery.net

Dillon Sykes, NHS Partnerships Manager and Joe McGrath, Product Manager for Livi have been developing the full patient journey via their website platform to connect to the NHSApp.

‘At Livi we welcome this new guidance from NHS England. Accessibility is not about sticking assistive technology onto the website. It is about building the website from the ground up to work with third-party assistive technology (e.g. screen readers). It is also about ensuring the website content is written in a way that is clear and understandable by the majority of users.  By using the NHS Digital Service design system, Livi websites are NHS branded, optimising functionality and providing confidence for patients to engage with online GP services (as well as other locally commissioned services and third-party tools). We believe practices should have generic accessible content and definitions of local service providers to help patients manage their own care. This approach has allowed us to build a practice website platform that gives practices back more time to spend on patient care by:

  • nudging more patients to digital services and appropriate alternative NHS services,
  • reducing the time needed to manage and maintain the website
Dillon Sykes, NHS Partnerships Manager

To the commissioners – let’s do this together….

Most useful in the website guide is valuable information for NHS commissioning teams to help procure GP websites ‘at scale’ and to know what to ask of suppliers in terms of user testing.  Perhaps now is the time to rethink the stance that ‘it’s a GMS requirement to have an online presence’. This must be the way forward to support local population communications and connecting the services at a local level for patients. It will support primary care network development and reduce the burden on individual practices to know and learn about website technicalities, so they can just focus on the message and how it is presented or accessed.    As more services are delivered together, why would we expect each separate practice to upload its own content and service description?  Surely this is done once by the local service provider?  Let’s take a current example.  Practices will all be delivering Flu and Covid boosters soon.  They need one single page for who’s eligible, then the ability to edit and add what’s happening locally, so that people know how to book and where to go.    Currently each website supplier may duplicate this, and some are good enough to offer a ‘Flu’ content page.  NHS England have issued the criteria in a Specification.  Public Health (UK Health Security Agency) have some promotional material, and poor practice managers will be trying to make sense of it all to tell their patients what is happening, whilst awaiting the final dates from vaccine suppliers and working out which members of the team can deliver.  One forward thinking area has thankfully collated all of this information together for its member practices and wait for it…… shared it as a google drive document to 200+ practices via email!!! That’s my Friday job folks – to upload and create this years Flu page.

google drive document containing all of the information required for 2022/23 Flu campaign

Hopefully, you can see where I’m going with this. Do we really need 6500 individual digital front doors?   I think not, but always open to be persuaded if you think the status quo is better.

Can I tell you about the Digital Journey Planner….?

Digital Journey Planner modules and home page banner

It’s been a while since the last blog, but you know by now that I am a sharer by nature, and I can’t help but want to improve things (which is not always welcome at home).  Yet there are many times when, even though the opportunity presents itself, we are just not in a place to see what needs to be done.  Primary Care has many of these opportunities but, overwhelmed staff perhaps can’t always navigate the complexity and volume of policy aspirations, contract changes and digital solutions intended to help.   So, offering suggestions to do things differently needs a considered and sensitive approach and finding the right time is crucial.

There are many competing priorities in digital health.  Some people have policy to implement, others have money to allocate and need to demonstrate value for that money.  Some people have services to deliver and want to give patients the best consistent experience. Some people have teams to manage, and all our digital development needs are different.  Confidence and competence levels vary from person to person and practice to practice.  I realise that there is an awful lot of variation in the elements of this paragraph, so I’m going to share with you, the journey of the Digital Journey Planner and how it is intended to address some of the above.  Because it feels to me, like this baby has had a long gestation, and now its ready for delivery, across General Practice in England – and I’m more than a little bit chuffed about this.

When did it all start?

One Saturday morning in July 2020, I posted a question into (one of the many) WhatsApp forums that sprang up at the start of the pandemic.  I wanted to ask if there was such as thing as a ‘digital maturity matrix’.  I was looking for something that was available to General Practice, to help assess digital progress, with a ‘checklist’ approach, of things that practices should be doing or offering and something that would help embed ‘digital’ as a way of working.

Thankfully, this generated a thread of enthusiasm from people in a variety of roles, some senior leaders, others commissioning or providing, and some were trusted (geeky) colleagues and people like me, who want to improve things. Game on!

What was I looking for?

I wanted to develop something that was easy to follow, that would curate the myriad of resources available to us into one place and was linked to improving service provision for patients.  I felt that we needed a modular approach, to address the various components or ‘building blocks’ but also to allow people to work at a pace that felt comfortable.  The modules would need to address service delivery such as GP Access, and it would need to help practices to optimise clinical systems and improve communications with patients.  All of this needs to be in place before we can successfully move on to do the more complex or ‘at scale’ stuff of Primary Care Networks (PCNs).  To encourage teams to invest in this process, we would need to help to understand ‘the Why’ or the benefits of digital General Practice.  I wanted this ‘thing’ to be a safe place for practice teams to be honest with each other about what they do and don’t do.  We had to find a way to motivate people to find the precious time to answer some questions, then to unlock their team’s potential through new knowledge and to improve their digital service provision. I’m extremely fortunate that Redmoor Health indulged this desire and that Marc Schmid, CEO and the team agreed that we should try and build this thing.  It was after all, the framework that the Redmoor Team use to coach and support improvement, so why not make it a self assessment, available to all.  We wanted to do this with the NHS, so thank you also to Dr Minal Bakhai and the Digital First team in NHSE&I for finding a way to support this effort.

What should we call it?

The name ‘Digital Maturity Matrix’ wasn’t really describing what we wanted though.  Commissioners need assurance and to understand the variation of their providers, so we’ve built a separate system to help with that issue.

Practices have different needs to commissioners; they need to know just what is ‘best practice’ and What Good Looks Like (sorry) doesn’t really do that for practices.  They also need to know what learning information is available, where to find it, how to access support and then teach their teams and work with patients to get the best bits for all.  Then they can share, so that others don’t reinvent the wheel.  Just like good old Strictly (apologies again, I feel like I am doing my own buzzword bingo today, but I’m going to use the ‘J’ word), a wise colleague suggested that ‘we are all on a journey with implementation of digital services’.  It’s not a static thing, so we need to baseline the start, see what’s to do and have a plan for sharing knowledge and best practice.  Perfect – the Digital Journey Planner was emerging.

What it does and more importantly what it does not do

Many great minds were keen to tell us what they didn’t want and here are some of the requirements from that initial WhatsApp enquiry.  It must not be ‘yet another bureaucratic paper filing exercise that burdens practices’. So that burned any ideas of spreadsheets that needed submission to someone, never to be seen again.  It mustn’t be used to ‘performance manage practices’ or people might fib (really?) when answering the questions.  I loved that one – it meant we didn’t have to build in any Red, Amber, Green or star ratings that could be both subjective and misinterpreted. It needed to ‘feel supportive and show practices how to get that support’.  It needed to be a ‘local roadmap (practice and PCN)’ and it also needed to ‘improve digital literacy….to maximise our GP IT systems and streamline processes’.

We were keen to make it accessible, so we followed the NHS digital service manual principles and we needed to keep it concise, so we have limited each assessment to approximately 20 questions taking no more than 10 minutes to complete.  If it was to address national priorities of making the right access easier for patients, we needed to share hints and tips based on our experience of working in and with practices and spread the best practice from those who are adopting digital healthcare well. 

Why we need it now

General practice has had so much pandemic pressure, dealing with the disease, the vaccination programme and staff shortages and isolation, we held back delivery in Dec 2020 and again Dec 2021.  Many Practices have had staff turnover during that period, and in many cases, IT solutions and products were thrown in with little time for real preparation, or consideration of changing process and engaging with people.  The technology adoption life cycle has literally been condensed into 18months. Practices had to rapidly change how they deliver services.  Patients had to get used to alternative methods of access and communication. All of this, however, presents us with the biggest window of opportunity to take the best, and run with it.

Who is it intended to help?

This version of the DJP is aimed at helping General Practice to improve.  It can also support PCNs to prioritise their digital agenda and develop together, to deliver consistency and to level up (I’m there again).  However already, we can see this process being developed with other sectors and themes.

To address the different needs of practice, commissioner and PCNs, we have two levels of access. Foundation access will be available to all practices, this includes access to the self-assessments and bespoke implementation plans.  Enhanced access is also available on subscription and in addition to the assessments and implementation plans, contains better reporting of usage and activity (not the assessment detail, which remains in the practice) along with additional help from the Redmoor Support centre to help embed the change required to improve.  More details can be found on the Redmoor DJP webpage.  We have been working closely to develop the DJP with a few areas and have already observed an increase in confidence and competence of staff, an increase in the digital maturity of practices and seen improvements to GP websites and GP online access to improve the experience for patients. 

The best bit for me – making life easier for Practice Managers and teams

As an ex-practice manager, I know first hand the complexity of the role and the volume of things you need to know about. They are often the conduit for all communications from Primary Care teams, Digital First teams, within Primary Care Networks and practices and with patients.  This DJP is to help you and your team navigate the digital landscape. So, here’s my advice, let your team loose with this – they cant get anything wrong – other than to learn from each other and come up with a simple plan to improve.  Oh, and don’t ask your Partners permission to do this either, just show them the implementation plan once the team have finished the assessments.  Then perhaps discuss within your PCN and do the work together and for each other. 

Thank you to everyone who’s contributed to this project

– I’ve got a good feeling about it….

PS, receiving these testimonials made me a happy person. 

Once I had completed the modules, I found the Implementation plan very useful and a clear guide to the area’s where we were doing well and where we could improve.  I felt reassured to read about the things we were getting right, the area’s we were doing well with and pleased to find help and support to hand for the area’s where we needed to improve.  I found it so helpful to be able to talk to someone and go through and be advised on a 1-1 basis of the area’s I was unsure about. The help and support I received enabled me to gain an understanding of something I was previously unfamiliar with and once demonstrated and explained, meant I could make a couple of quick changes to improve patient communication

I found it really easy to work through, I like the fact it is split into sections making it very user-friendly and enabling us to focus on one area at a time. The assessments that are produced when you have completed each module also give you a good structure to where we could be focussing our efforts.

Things we are doing well – good section as recognising what we have got right

Things we can improve – I made this my to do list which I am working through for each category.

General Feedback – Additional resources were good. I picked up a few things that I hadn’t thought about before:

  1. Google my business – and using this to its full capacity, the link to the video was very good and gave me a good understanding of what we can do.

2. Patient Feedback – Utilising this to our advantage

3. The links you gave to case studies and Youtube videos were very helpful and a resource I can use again

GP Websites – time for a rethink?

A couple of years ago, I wrote a blog about GP websites and posed the question ‘GP Websites – just what is their primary purpose? In it, I attempted to describe all of the challenges that practices faced and why it was often a job for the ‘to do list’. 

Little did we know then that over the next 18m, these websites would become so central to patients accessing the NHS via their GP.  With the Covid19 restrictions and subsequent lockdowns, often the only place where people could find information about how to access the NHS, was via their GP website or a practice social media account.

Many practices quickly uploaded details of what to do if you might have covid, how to access services and introduced many new alternatives, such as online consultations and signposting to useful nhs.uk and gov.uk covid advice.  Yet many practices still haven’t updated their core content or capitalised on this opportunity to engage with people in a different way.  The time has long passed where we rely on the posters in the surgery and there are some great examples where practices send out weekly updates of common enquiries, either by large scale messaging and/or via social media. But as the restrictions are lifted, some sites still contain out of date service details, (despite services being decommissioned) – for example covid ‘red hub’ assessment centres.  

I’m not at all being critical of Practice Manager colleagues with this observation. This is back to the many issues raised in the original blog; most likely down to sheer workload during the vaccine programme, with staff working remotely, in isolation or off ill alongside the myriad of other tasks necessary to keep services operational.  But I do get asked a lot about why there remains such variation and what can be done to help?

Interestingly, many practices have remained loyal to their existing website provider, despite some eye watering prices, and rather than shop around for other providers who may have improved website design significantly, they are stuck with poor design templates and an inability to update easily.  I still see plenty of examples of sites ‘written by the brother-in-law’ who is clearly oblivious to the emerging good practice.

The research from UCLAN (password is uclan) and the NHS Digital Service Manual fed into a technical standard which NHSX released to all of the major website providers last year.  This accompanied guidance for GP Websites and online presence created to include all the ‘things’ you should have on your site to help people to find the right information, as well as to save practice time (you’ll need a Future NHS account to access these links).

  

So, to those website providers who don’t meet this technical standard or follow this design manual – maybe its time to do a bit of soul searching and ask why your templates are still not quite meeting Web Content Accessibility Guidelines (WCAG) 2.1 requirements and checkpoints.

At Redmoor Health, we are lucky to support some fantastic teams in General Practice and to work alongside some very understanding NHS Commissioners, who want to help inform their population and to ensure a consistently high standard of digital access for all.  Together this lends itself to a standardised approach to GP Websites and several Commissioners are now thinking differently about who creates content for these sites, i.e., they realise that they are no longer just the domain and responsibility of the practices.

The team at Redmoor have been helping practices to focus on Patient Communications throughout the pandemic and we include advice, hints & tips and support about various forms of digital communication.  This includes use of social media, smart use of messaging systems and how to optimise GP Websites.  

We’ve hosted a couple of webinars and worked with industry specialists such as Tim at GPsurgery.net and Thomas at iatro practice365 to help deliver best practice guidance.  Through these sessions we have provided advice on accessibility and inclusion, how to use analytics to inform digital service provision and shared the key elements that patients need to find on your website to avoid unnecessary calls or to get help when you are closed.  

This is resulting in a number of conversations across PCNs and CCGs and people seem much more willing to do this collectively.  People are now seeing the opportunity to reduce variation, remove duplication and save everyone time, whilst offering populations common access and experience of GP websites.  

We have built this approach into our thinking with a new coaching and support webtool for General Practice – the Digital Journey Planner.  We now have several creative Commissioners embarking on using this webtool to engage and support their practices, to baseline current experience, deliver consistent knowledge and learning to the practice teams, whilst identifying the key areas where Commissioners can offer support to remove pressure with combined patient communications. 

It feels like we’ve come a long way since Feb 2019 – get in touch if you’d like to find out more – just ask hello@redmoorhealth.co.uk

#Team GP – its tough out there, but OC is not the only problem

Slight understatement – we’ve got a bit of a challenge at the moment, we all know its tough in #teamGP in general practice right now. Most know its due to imbalance between funding allocation, capacity and demand and there are a number of great blogs out there; this one, We were never closed from Dr Abbie Brooks @DrAbbieSBrooks prompted me to offer my thoughts.

At Redmoor Health  we try to help practices with digital change.  We try to help embed tech and digital ways of working to make practice’s lives easier.  We also try to explain why this benefits patients and practice teams, helping those that can, to self serve, whilst releasing time to support more vulnerable and in need.  We are commissioned by NHS organisations to do this, as they try to implement policy directive, whilst offering support and balancing the need to ensure value for money at the same time – no mean feat.  And all of this is happening at a time where patients have been ill with a novel virus, some have lost family members to covid, are in fear of getting covid, or have been vaccinated to reduce the effects, on top on their pre-existing (possibly deteriorating) conditions and any new health concerns.  No wonder everyone is tired and fraught, and I hope our offer of help comes with the understanding that we know how challenging it is out there right now.

Access and online consultations….

Some say, that enabling online services mean that ‘the floodgate is open’, in fact one GP actually said that they’d hold me personally responsible if they switched on Online Consulting (OC) and then couldn’t meet the demand.  And perhaps some (in my opinion) wrongly blame the tech for this surge in demand. Others are more honest and know that previous methods of access to general practice were unfair and not based on any sense of clinical need or priority.  The ‘sorry, everything is booked, please ring back at 8am tomorrow’ never worked or landed well.  Perhaps a small minority of GPs were actually unaware of their access problems as the ‘good old Reception gatekeeper’ managed to shield them to an extent. Most know the main reason is lack of GPs and staff leaving due to increased pressure.

Triage….

Good practices have been triaging for almost 10 years so moving from Telephone to Online Triage wasn’t a huge step forward.  But patients are individuals with their own problems, each one is important to them and not in any way relational to the next, ‘more ill’ patient.  So, many people have no concept of clinical prioritisation or indeed the pressure in the system, at the time that they become unwell.  They do what they’ve always done, either ring the GP or look on the website.  What’s the first thing that many see? ‘Consult with your GP now’. 

Online Consulting and your website…..

Job one for practices, look at the placement of your offer.  Unless you have a wonderful system that offers self care as part of the triage process, make sure that your site offers self care first. Then explain what to do and where to look for information when you are closed, and then show the online consultation banner.  

Patient and practice expectations…

Also, the change in culture of 24/7 access to everything and ‘need it now’ convenience is driving the demand, supported by some influential but irresponsible mainstream media headlines.   At the end of the day, I am one patient, I might use all modes of access, but not all at the same time.  Why wouldn’t a patient expect to use these methods? They do for every other aspect of daily lives. This last year, I’ve used online consulting, had telephone triage calls, been seen and referred when needed and sent images via text solutions to help the process along.  Each time, I’ve understood when and how a reply may arrive, but that’s because I work in the system, not necessarily because that information is available either on a website or via other methods of communications.  We know that many practices still struggle to blend the multiple routes of access, planning this into their workflow and so try and restrict to fewer options for patients.  This is perhaps what seems to increase the OC demand, because GPs are now seeing stuff come via OC that previously other members of the team would have dealt with, if the enquiry had come in by phone or in person.

Practices ask for ‘one system/thing that does it all’ to help with this. Believe me, training teams on multiple platforms with similar names and functionality isn’t easy so I understand this request – but there isn’t one supplier that currently offers it all – there is a blend of online services, online and video consulting and use of messaging systems from suppliers and a ‘marketplace of offers’ of functionality that is mind blowing; no wonder we can’t choose the right product to meet everyone’s expectations.

Education and awareness

Our biggest challenge is how to educate people, on what’s available, what to try first, and how to seek help when needed; making this information inclusive and easily accessible and known about, even when patients are not ill.   NHS.uk have worked hard at improving their website resources, and a number of website suppliers have improved their site templates well, but many practices have yet to benefit from this. 

Within practices, the challenge is how to create this information and disseminate it to local populations, but we should be doing this collectively and not as separate individual practices.  Many seem to struggle to articulate this ‘why, when, what, who, how’ approach into patient communications, most likely due to workload pressures or even time to think about it from the patients view.  

PCNs – the digital opportunity…..

So, primary care networks (PCNs) offer this opportunity and the covid vaccine program has enabled great collaboration, supported by some super tech, software and motivated teams to work differently.  We need to keep this way of working and think wider than collaboration for just vaccines.  Let’s use the PCN structures and new team members to think about consistency of communications, education of the right route of access for the problem, what to check first and where to look before contacting your GP.  And let’s use the power of community networks and social media to share this information.  

How many PCNs have digital communications on their regular agenda or are building networks of digital champions both in their workforce or communities?  And if you’re in a commissioning role and haven’t already done this, please get chatting about blending Digital First, Primary Care & Workforce commissioning together, because one enables the others and your pooled resources will go much further.

Get in touch hello@redmoorhealth.co.uk if you want to explore further, we’re all here to help each other.

GP websites – just what is their primary purpose?

A colleague recently shared a research project they are working on; ‘What does a good Primary Care Digital offer look like?’ We chatted a bit about GP websites and ways that we try to communicate with patients and I delivered one of my usual unstructured ramblings, so thought I’d share some of this with you and ask for views please.

Introduction to the project

When I heard about this research, my first response was to ask if I could join the project too.   Primarily I wanted to be sure that someone who worked in general practice could offer an operational perspective. I also wanted to avoid ‘a solution’ that would make more work for already very stretched, practice staff. Having been a PM for 8 years and been working with Patient Groups for more than 15 years, I have an interest in using digital solutions to communicate widely and have a few connections in the world of digital and user experience design; I thought it would be a nice opportunity to work together on this.  Like many practices, I knew that our practice website was due a refresh; we’d signed up with our Website provider in 2012 and although fiddled with it a bit, not really changed its look since.  There have been software updates, but as we had been on the cusp of joining a new organisation for some time, I kept thinking we would wait then create a combined practice site with a more corporate look and better functionality. So, here’s the first question, as a patient or carer, how do you receive information from your GP surgery? Have a look at your GP’s practice website and see when it was last updated and ask yourself, does it contain the information I need?  What other stuff is on there that you didn’t know? If you have a health related question, where do you search for information? Let me know and we can try and ensure we signpost to this.

Why are websites never up to date?

The word Everything on a To-Do list on a dry erase board to remind you of your tasks, priorities, goals and objectives

Reasons for not updating websites frequently are many, but usually due to time pressures. I also had a fear that if we changed the layout, we’d be inundated with concerns from patients asking where things had moved to – a bit like moving items in the aisles in the supermarket.  Although we add information fairly regularly, the process is clunky; the site’s formatting and design aren’t that user friendly and from a practice perspective, it’s just another job to do.

Value for money or too expensive?

Funding a new website is also a thorny issue. Bigger (or better funded) practices may invest in a bespoke product, smaller practices may see this as an added luxury. A good website should deliver value for money, especially if provides patients with information about the right service for their needs or links to local, relevant advice on ill health and disease prevention and selfcare. A priority for the health service right now is the need for people to use services responsibly. The NHS is so complex, how do people know where to go; use 111, local walk-in centre, general practice, specialist community service, A&E – the list goes on. General Practice is viewed as the front door to the NHS so the assumption is that its their job to signpost patients. But is it really the GPs job to describe all of the various options? Good website content and design should help with quick access to information and good signposting to services without having to wait in a telephone queue. Yet many practices buy the basic off the shelf, template based site for less than £500 per year and give little direction in terms of where to go in the NHS. Perhaps all of those other services should provide information about when to visit the GP?

From a site ‘visit’ perspective, we can no longer access visitor and page view statistics, so we don’t really know how many people visit or if the information is of value.  The world of website analytics is unknown to many practice managers. 

So, where do Practices look for a website provider….

There are a number of proprietary providers that most practices use because they are recommended on Forums (Practice Index, Practice Manager facebook forums etc) or linked to other existing service provision (MysurgeryWebsite, Wiggly Amps, Egton). The question ‘who do you use as your website provider’ has been posted numerous times in the last 12m.

These sites are usually hosted and come with an element of local tailoring with set templates for you to choose from.  Many practices just go with the basic product as delivered from the supplier on day one, others clearly spend time thinking about the look and content. Historically, they tended to be desktop based versions, but increasingly they are adapting to be suitable for use with mobile options as more patients use a range of devices to access healthcare information. I’m told by our provider, that we have a legacy system and waiting to see the demo of the new Digital alternative.

A GP website is a repository of information with links to other useful sites, but often they contain lots of repetition and page changes, with the user losing their way from an initial enquiry. Patients can spends time surfing around for key information, yet still many practices don’t even have the basics of an email address or a number to text for general contact enquiries.

Functionality –   Front facing and back office?

There are website providers that not only host information but also gather patient information too, through use of online forms.  They attempt to ‘stream’ patients enquiries through to specific teams i.e. admin, medication enquires or clinical care (e.g. asthma questions).  They are sometimes partnered with other recognised ‘Online consultation’ forms.  These sites are helping practices to carry out vital data capture and also provide a form of triage, but how are practices assured of the risk i.e. data protection, clinical good practice etc.  Some practices are cautious of opening up other channels to receive additional work streams, especially as not all are integrated with the practice Clinical Health Record system, so clinical coding is missing. Maybe these functions should be viewed not as ‘additional’ but alternative ways of dealing with enquiries; better than a wasted GP appointment for a simple non-clinical enquiry, no?

Many website providers also offer a ‘back office’ or intranet function for practices to create and store information such as contact lists, room schedules, staff rotas, significant events, fridge temperatures, procedures and policies etc. These are used by the whole team and contribute to appraisal preparation and evidence of compliance for regulators. Increasingly these functions are being replaced by better compliance and collaboration tools such as GPTeamnet, Fourteen Fish etc

Do practices have the right design and communication skills?

I don’t mind admitting, I’ve got ‘font and layout’ issues and the limited text style irritates me, so I don’t enjoy this job when there are so many other things to do, but I never seemed to make the time to learn how to use it properly and I know that many Practice managers are the same.  I also don’t have the design skills to make the layout effective or to incorporate graphics or images that replace the written word.

Although template websites have a range of options to choose from, the design and formatting functionality can be somewhat limited and clunky.  It’s fairly easy to spot a bespoke high quality design from an ‘off the shelf’ template.  Most practices wouldn’t know where to start in terms of placing the most frequently used pages/items at the front, or create eye-catching designs that engage users or communicate effectively.

Web designer

NHS Digital have kindly provided guidance for us to follow – I shared it recently with other Practices and doubt anyone has actually read it or made changes as a result – I know I haven’t had time.

This is part of NHS Digital, creating standards intended to ensure accessibility and inclusion and good user experience.  Many websites still don’t address the increasing need for good accessible design and practices buy with the hope that their site meets the legal requirements for accessibility and inclusion. This guide is great for designers, but well above the skill and knowledge level in most practices and I wouldn’t know where to start checking our current provider against these standards. What would be helpful is that anyone who provides a website service can demonstrate they meet this standard, so that practices can be assured before they purchase.

NHS Generic information repeated?

The new GMS GP contract requires practices to have an up to date and informative online presence by 2020 (page 35). If we are to adopt a ‘Digital first’ approach, for those users who choose this, then a website’s original function is being overtaken by many other products. There are apps here, there and everywhere and more practices are using social media to share information quickly and widely, as well as traditional newsletters and posters in the surgeries.  There are many more online services to offer or ways for patients to access these services via alternatives to web browsers.

But don’t forget that NHS.UK (not called NHS Choices any more) has already created a unique site for every practice and some of the National dataset for performance links to this site i.e. star ratings and comments about service provision.   Having a practice website has been a minimum General Medical Services contract requirement for some time, but I doubt many practices update their NHS.uk one as well as their own site.  Most will just link to their own website. So each practice probably has links to GP survey comments, star ratings, who’s who, when we are open etc held in multiple places and this is another reason for out of date information. The connection to NHS.uk is provided from the clinical system provider (i.e. what online services are connected) and feeds into national contract management tools such as the Primary Care Web tool.  This is also the place where CQC look for feedback and comments.

Primary care working as networks

As more practices federate and work as networks to deliver shared services, access and common information should be provided via one page and not duplicated on separate sites.  Although some practices want to retain their own ‘front door’ to maintain familiarity for patients, most would happily hand over the ‘back office’ role of updating websites and linking to other NHS services and content. Will this be high on the priority list of any newly formed network?

Social Media, Reviews and Comments

Now things start to get interesting as people ‘check in’ and review their experience using tools like Facebook, Google review and I Want Great Care .  These platforms encourage patients to ‘like’ or ‘comment’ following attendance – practices can choose to ‘own’ these sites and respond, or ignore but are unable to remove comments so they may sit there, open for others to view unanswered.  Some practices hate this and are really fearful of data breaches as well as opening up other channels of communication. They may have a negative experience of social media and don’t want additional work of training staff to work safely and professionally in an area that crosses over with leisure and out of work activity.

However, if used wisely, social media offers highly effective alternative methods of communication for mobile users.  This recent post by one practice reached over 1m people to advise them about cervical screening services. This encourages interaction rather than one way push of information and has the ability to reach quickly and widely with little effort. 

More and more practices use social media and message solutions to communicate with individuals, groups and whole sections of the practice population as well as providing opportunity for ‘communities of interest’ and large scale communications at federated levels of General Practice. This has to be part of any new communication system.

Access to online services

As more services are delivered online, then application developers are providing better alternatives to the GP practice website for transactional services like booking, cancelling appointments, ordering medicines etc. There is a market approach to the development of these online services and practices are struggling to keep up and train teams to offer knowledge and advice on the options to their patients.   Each app seems to deliver different functions which means that app of choice will depend very much on the need of the individual patient.
Depending on the provider, some websites link to a practices clinical system for online services but can only offer one online service and not multiple options. Although patients can choose from a number of different platforms to access online services currently, website providers haven’t enabled this choice. This limits practices and patients if people want to offer and use a variety of online services. The only way to do this is to signpost using weblinks rather than widgets to apps to advertise the options to patients.  All four current  providers; Evergreen Life, Patient Access, Dimec and Iplato all have apps to access booking, cancellation, messaging, medication ordering, medical records viewers etc but not all have browsers. Conversely, some of the online consultation systems only use browsers. The NHS app is due to roll out imminently, but as yet, we don’t know how this links to a practice website or browser option.

Conclusion

As you can see, its detailed and complex and really does need a review.
The work that UCLAN are doing with the NHS Primary Care Digital Transformation team will help inform what a good Primary Care Digital offer looks like. We need this to help practices buy and recommend the best products with confidence. We also need to know what content is most useful so that we help guide patients to the right service for their needs, quickly and easily.  So I’m glad this project is started, but let’s think first, what’s the purpose of a website and who is this project aimed at?  Please do add your comments and we will see if this can be added to the research.