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Providing online services for patients

Both patients and practices can benefit if the surgery provides access to services online. Practice manager Johan Taylor explains how to get started.

Johan Taylor: 'Reduce admin and queues at reception' (Image: Judge & Howard)
Johan Taylor: 'Reduce admin and queues at reception' (Image: Judge & Howard)

Many of the patients you saw today will go home and use the internet to manage their bank account, shop, learn and socialise with friends and family. So why do so few of them use it to interact with their GP surgery to so book appointments and request repeat medication?

The answer is that while the technology is available, many GP practices are not routinely offering online patient services.

That is set to change.  As part of its strategy to give more power to patients, the DH in England has set a target of online access to medical records for all by 2015. It also requires practices to offer online appointment booking and email access. Like it or not, online patient services are here to stay. 

Practice benefits
The good news is that it is not just patients who benefit from online services: there are many advantages for the practice and GPs too. You can cut down on admin, phone calls and queues at the front desk; reduce prescription errors and potentially involve patients with chronic conditions more in their own care.

I know this because we have been doing it for more than 10 years here at the Marple Cottage Surgery, Stockport with the aim  to offer patients as much choice as possible over how they access the practice.

Today, just over 1,000 of our 6,400 patients are signed up for online services. So what does your practice need to know to get started?

Get your patients’ views
It sounds obvious, but start with your patients.  Do not assume you know what they want – ask them. A good way to do this is via your patient participation group: ask them to canvas patients’ opinions about interest in online access and what services they would find most useful.

Then bring everyone in the practice together, from receptionists to the senior partner and agree a policy for introducing online services, how it will operate, and who will monitor it.

It is vital that all team members ‘buy in’; you need support from the whole team to promote the services. Allow time (this may involve a few meetings) for any concerns to be aired and dealt with. 

Different software options
There are many different services you can now offer online and many of them are integrated within the main GP systems.

We launched a basic in-practice online appointment booking system in 2001 and upgraded to another (EMIS Access) in 2003.  This enabled us to offer new services like online repeat prescriptions and secure messaging. At the same time, as we wanted patients to have more flexibility in how they obtained medication, we also gave them access for repeat prescriptions ordering via  internet pharmacy (Pharmacy2U) which provides free delivery of medication to patients' homes or to any address they nominate.

This allows patients to request medication by phone or online without contacting the surgery. We have an electronic link with the pharmacist that enables us to quickly communicate repeat prescriptions changes, and allowing the pharmacist to explain the reason for early or unusual requests from patients.

Medical records access
Later, we introduced the online medical record viewer facility, giving patients full access to their medical record. This may be a contentious area for some GPs, but we feel that this enables self-management of long-term conditions as patients take more interest in their records and health.

We developed this further by offering asthma patients an online questionnaire, which is sent securely and filed and coded directly into their medical record. Areas of concern are acted on immediately.  If no immediate action is needed, the patient’s self-management plan is updated and the patient can view this online. 

This is not a replacement for a face-to-face consultation, but offers a way of maintaining communication between patient and practice – ideally more regularly than annual reviews – while freeing up appointment times for the practice.

Challenges to overcome
Many practices are concerned that patients may abuse online services – for example, booking unnecessary appointments or bombarding GPs with emails.  We have found the reverse: patients use online appointment booking sensibly, and they can resolve simple queries via email without an appointment or a phone call.

The main challenge for us was getting the clinical staff on board as not all were convinced of the benefits and we needed to take a step-by-step approach to some projects.

Educating patients was another: there are still patients who do not know that we offer online services, even after big ‘marketing’ campaigns. 

Tips for getting patients online
  • Start with the patients – what services will they find most useful? Time-saving services such as repeat prescription management and appointment-booking have widespread appeal. 
  • Get everyone on board - from receptionists to GPs.
  • Actively promote your online services. We found one of the most effective ways was for GPs to give out information during consultations.We also use posters, newsletters, our website and the local media.
  • Have a clear policy – what are you offering patients, and how are you doing it? For example, are you offering services to all ages, or restricting to over 16s?  You need to consider the consent issues surrounding this.
  • Ensure patients already have good access before starting. Online appointment booking will work if you start with a three-week waiting list to see a particular doctor.

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