Last November, under health secretary Jeremy Hunt’s stewardship, the DH published a mandate for the NHS Commissioning Board (NHSCB) for the period April 2013 to March 2015.
The NHS Mandate, which applies to England only, set some controversial objectives for the NHSCB to achieve by March 2015, to help people manage their health and care using IT.
General practice objectives
The mandate states that by March 2015:
- Everyone who wishes will be able to get online access to their own health records held by their GP. The NHSCB should promote the implementation of electronic records in all health and care settings and should work with relevant organisations to set national information standards to support integration
- Clear plans will be in place to enable secure linking of these electronic health and care records wherever they are held, so there is as complete a record as possible of the care someone receives.
- Clear plans will be in place for those records to be able to follow individuals, with their consent, to any part of the NHS or social care system
- Everyone will be able to book GP appointments and order repeat prescriptions online.
- Everyone will be able to have secure electronic communication with their GP practice, with the option of e-consultations becoming much more widely available.
Where some of these objectives will be CCG-led such as telecare, telehealth and secure linking of records, others will fall into GP practices’ remit.
As scary as a deadline of March 2015 may seem, by pacing yourself and with the right planning, you could get the NHS Mandate to work for you and your patients the way you want it to.
Start with an easy step
With the majority of practices using EMIS and TPP SystmOne clinical systems, the functionality for online appointment booking, repeat medication requesting, viewing medical records and secure messaging already exists. So the tools are already there for you to use if you wish.
One of the easiest steps to achieve is online appointment booking. This is a great way to see the benefits of online services. Patients are able to book appointments 24/7. Meanwhile, for practices online booking reduces patients’ visits to the surgery and phone calls asking for an appointment.
Before you do anything, you need to plan ahead. As with most new initiatives preparation is everything, and you will need to inform staff and perhaps ask them to help design the way that you approach the IT objectives.
System suppliers offer different ways to configure your online appointments service to what best suits your practice. This includes how many appointments and which slots you want to offer, and which clinicians you want patients to be able to book to see.
First, ensure that your system is enabled and set correctly. Using EMIS as an example, this configuration is in System Tools – EMIS Manager. If you are new to online services, enable the online appointment booking first before trying the other online options. This way, you can choose when and if to switch on other options.
To enable the online services EMIS offers, you do not need to have your own website – patients can book through the patient.co.uk website. If your practice has its own website however, you can create a link to the access page.
Once you have enabled the access in EMIS Manager, you need to look at appointment slots and identify which sessions and/or slots you want to enable for online access. The staff member who sorts out appointment sessions can set this up quite easily. System suppliers provide step-by-step guides if you run into problems.
Again, the practice has total control over which slots it wants to offer online. Extended hours slots would be a good choice for online booking, but perhaps not the first few appointments on a Monday morning.
When you have set up the appointment slots you want to offer, you need to enable which clinicians patients can book to see. This function is easy to find under user configuration.
Another option would be to set how many appointments you wish a patient to be able to book at any one time. A good start may be to opt for two or three over a 45-day period, but tinker (and re-tinker) as you wish. These settings can be changed at any time.
Promoting the service
Once the service is set up, you will need to make sure that all practice staff understand how it works and then promote it to patients. Staff (especially reception) will need to hand out log-in codes to patients.
For governance issues, you may wish to consider only allowing adults over 18 to have access to this initially to ensure confidentiality issues don’t arise.
A few months after launching online booking and reviewing the uptake and impact on the practice, the next step may be to consider introducing online repeat prescription requests.
The next step after this may be allowing patients to access their medical records.
This can be good for selected patients with chronic conditions. The information can be configured, if you wish, to prevent free text data from being viewed and a limit can be set for how much data going back in time is accessible.
Encouraging uptake of online services is definitely the right direction of travel. But the March 2015 mandate deadline for strategies such as allowing patients to communicate with practices (let alone clinicians), which are fraught with governance and workflow issues, may prove unrealistic for wide-scale roll out.
- Dr Osman Bhatti is a GP in east London at the Chrisp Street Practice