GP Online Services

Patients may need help to know about the new modes of access. Some services are transactional (e.g. ordering medication) and can be a much better experience if conducted digitally than waiting in the telephone queue. Practices can now deliver care asynchronously for many patients helping to avoid the ‘8am rush’. To avoid patients defaulting to telephone first, GP practices need to think about how they are guiding people to access services online. Research has shown that rather than having an online consulting system ‘widget’ on a GP practice website home page, it should be part of the Appointment booking flow on a GP practices website, along with signposting to the NHS App as one method to book, change or cancel Appointments. The Appointment page should also describe how to access Appointments in the evening and weekends, or if a GP practice has extended access services provided in their PCN or Federation, and how patients can access these services.

The GP Survey in April 2023 shows us that nationally, 43% of respondents said they used A&E when the practice was closed. GP practices need to increase awareness and use of NHS 111 online, NHS App, and NHS.uk content such as symptom checkers, NHS service finders, Health A-Z and Medicines A-Zs to support patients to first find the right service for their needs, at the right time.  Some of this is general help, others specific at the point of need but the more people are aware of them, the more likely they are to select these options before using other services like A&E, which isn’t always Appropriate or the most effective source of help. As well as clinical help there are some practical pages too for patients who may be waiting for hospital care. Find your NHS number and MyPlannedCare helps patients with their hospital enquiries, with information about preparing for hospital Appointments, waiting times and looking after themselves whilst they are waiting to support patient expectations as well as looks to reduce administrative tasks for staff.

Now that online access to GP detailed coded records is live in over 70% of practices across the country, and 93% in the South East region, there are lots of resources to help practices inform their patients how to do this. A good place to start is (what was then) NHS Digital’s – Inform patients about having access to their online GP health record information through the NHS App – NHS Digital contains suggested digital content and images for website, social media, messaging including the links to all the places that patients need to go to, to find out more.

Online GP practice registration service

The Register with a GP surgery service is free to all practices and is designed and run by NHS England. The service gives all GP practices in England a standardised way of receiving registrations online. It makes it simpler and more accessible for patients to register with a GP and easier for practices to manage registrations. It allows practices to receive patient registrations online quickly and easily, automatically checking if the patient is in the specified GP Practice catchment area, therefore saving practices time spent matching patients to their NHS records and offering digital patient identity checks through NHS login. Currently, the system isn’t integrated with clinical systems for direct entry to the records, but this is a roadmap feature for 2024. In the interim, to view progress use this dashboard and click here to view suppliers currently supporting robotic process automation (RPA) for registrations.

The service now notifies patients via a message confirming the practice has accepted them as a new patient. Responses can be sent via NHS App, email, text, or post if patients cannot be reached digitally, From 24th October 2023, all existing and new practices signing up have the feature enabled by default but can disable it via profile manager if they choose. The service is free to all practices (and could save money for practices by not needing to send SMS messages etc.). Messages are not sent if: patients are rejected by practices, patients are registering in England for the first time, or if they are moved to practices via bulk transfer (e.g. such as through practice mergers).

Benefits for GP practices

  • free to all practices
  • saves time when capturing new registration information
  • streamlines Registration process
  • auto checks address against practice boundary
  • connects the patients with the NHS Spine details for ID verification
  • less paper

Benefits for patients

  • integrated with NHS App
  • can start the registration process without needing to contact the practice
  • saves time using NHS Login details and no need to copy and bring in ID
  • simpler user experience

Resources

Online GP practice registration service

The Register with a GP surgery service is free to all practices and is designed and run by NHS England. The service gives all GP practices in England a standardised way of receiving registrations online. It makes it simpler and more accessible for patients to register with a GP and easier for practices to manage registrations. It allows practices to receive patient registrations online quickly and easily, automatically checking if the patient is in the specified GP Practice catchment area, therefore saving practices time spent matching patients to their NHS records and offering digital patient identity checks through NHS login. Currently, the system isn’t integrated with clinical systems for direct entry to the records, but this is a roadmap feature for 2024. In the interim, to view progress use this dashboard and click here to view suppliers currently supporting robotic process automation (RPA) for registrations.

The service now notifies patients via a message confirming the practice has accepted them as a new patient. Responses can be sent via NHS App, email, text, or post if patients cannot be reached digitally, From 24th October 2023, all existing and new practices signing up have the feature enabled by default but can disable it via profile manager if they choose. The service is free to all practices (and could save money for practices by not needing to send SMS messages etc.). Messages are not sent if: patients are rejected by practices, patients are registering in England for the first time, or if they are moved to practices via bulk transfer (e.g. such as through practice mergers).

Benefits for GP practices

  • free to all practices
  • saves time when capturing new registration information
  • streamlines Registration process
  • auto checks address against practice boundary
  • connects the patients with the NHS Spine details for ID verification
  • less paper

Benefits for patients

  • integrated with NHS App
  • can start the registration process without needing to contact the practice
  • saves time using NHS Login details and no need to copy and bring in ID
  • simpler user experience

Resources

NHS App

The NHS App has undergone significant development to become the App of choice to access NHS services, the redesigned NHS App will make it simpler for patients to find the services they need. In addition to accessing GP services, patients can now also access referral information about their hospital and community services, begin their online consultation journey and receive messages from the practice.

The South East region currently has 58% of our population over the age of 13 already registered to use the NHS App and is on track to meet the NHS target of 75% by March 2024. As practices continue to encourage sign-ups, they can monitor their uptake and utilisation via the NHS App Dashboard.

Benefits for GP practices

The NHS App can offer the following benefits to practices:

  • offers online consultationsthrough several service providers
  • includes an NHS App messaging service, which:
    • is more secure than other message channels, e.g. SMS (texts)
    • can reach the patient regardless of changed phone numbers or different practice registration
    • can be longer and richer in content with branding, linked text and interactive elements
  • secure messagingenabling patients to send non-urgent enquiries to the practice (EMIS and TPP clinical systems only) who then sends replies via the clinical system 
  • access to patient recordsallowing patients aged 16 or over to see information contained in their health record, including allergies and adverse reactions, medications including acute medicines, repeat medicines – both current and discontinued, test results (new results will be visible only when filed) historic results (potentially as far back as 2002) consultations (including free text), events and documents
  • linked profiles and proxy access,once a GP practice has set up a proxy or delegated access, a patient can use the linked profiles feature in the NHS App  
  • online Appointment booking, making directly bookable Appointmentsavailable for patients to book online will help to reduce staff time spent on the telephone, as well as empower the patients to manage their own Appointments   
  • patient interaction with referrals,for referrals made through the e-referral service (e-rs) patients can book, check, change or cancel their Appointment, reducing the need for practices to print and post booking instructions. Practice staff will be given the option to send documents electronically if the patient has the service enabled
  • prescriptionordering, with the option of the patient nominating a pharmacy for dispensing 
  • updates,guidance on the latest updates and releases

Benefits for patients

Patients can use the NHS App to:

View messages, in a secure inbox, from the NHS App, from their GP practice or other healthcare provider – notifications must be switched on in the App settings to be alerted to incoming messages

View linked profiles, which enables family members/carers to access health services on behalf of the patient – this has to be enabled by the GP surgery as a proxy or delegated access

Securely view the GP patient health record, to see information like allergies, and current and past medicines – patients can also see information like filed test results and the details of consultations

Order repeat prescriptions, from a list of available medicines, and choose the dispensing pharmacy. They can also see the previous order

Book or cancel Appointments at their registered GP surgery and see details of upcoming and past Appointments

View referrals and other healthcare Appointments (if the practice has enabled this service)

Get health advice, for example:

  • about Coronavirus
  • find trusted NHS information on the NHS website’s Health A-Zpages
  • use an active link to NHS 111for online help and guidance or when to call 111 instead
  • answer guided questions online, through a linked online consultation service provider to get a response from the patient’s registered GP practice for themselves or for a child

View NHS number, visible on the home page 

View and manage care plans (if the GP practice has enabled this service)

Register for organ donation, and subsequently manage patient choices through the link on the App

Choose if confidential data from their health records is shared for research and planning and also change any decision through the App –

Get help with technical issues, with troubleshooting advice and a link to contact the NHS App team

Access account information and settings, for example, fingerprint, face or iris logon can be enabled, legal information, including terms of use/ privacy policy/accessibility statement/open source licences, and the use of cookies Current platform allows patients to be able to access the service even if they update mobile number, smartphone, etc.

Access a help function, with advice about a range of clinical issues like mental health and urgent medical assistance, as well as help with the App functions, like messaging

Internal Resources for Practices

External Resources for Patients

Online Appointment booking and cancellations

Many practices are still concerned about GP capacity, but there are still plenty of opportunities to offer online booking, especially for planned care. Think wider than just GP Appointments and ensure that anything that can be prebooked is available to book online too, ensuring equity of access and allowing patients who have been requested to have a follow-up, clinic review, medication review etc. can book online. Guidance for directly bookable Appointments offers suggestions for the types of Appointments that can be booked online. Some patients may prefer to continue using other Approved patient-facing service Apps to book and cancel their Appointment, GP practices can still view this activity via the Patient online management information portal for all online Appointment data.

It is important to have an open Approach to using these technologies in general practice. Sometimes restricting access to or disabling features of online booking systems can exacerbate demand and capacity issues when  switching certain functions off or having them only in certain days/times of the day, as it just funnels demand into peaks at different points in time. Some of these tools will actually help manage that demand more effectively and easily. Therefore, it is important to use the resources below to optimise online Appointment and booking systems.

Benefits for GP practices

  • Reduction in unplanned surgery visits in person to make, cancel or reschedule Appointments
  • Reduction in telephone calls to make, cancel or reschedule Appointments, reducing pressure on phone lines (which can have an effect of reducing call wait times overall) and practice staff
  • Potential to save staff time with less direct patient contact, particularly when booking high-capacity clinics such as seasonal vaccination clinics
  • Fewer missed Appointments – NHS figures released in 2021 tell us that it is 21% less likely that a patient will fail to attend an Appointment booked online
  • Where a patient uses the option of including a reason for the Appointment, an opportunistic review by a member of the practice team may suggest there is a more Appropriate person to deal with the problem, and the patient contacted accordingly (remembering that patients still have the option of seeing a specific/preferred clinician). For staff trained in care navigation, it is relatively easy to identify if an Appointment is with the wrong clinician however the onus will always be on the patient making the booking

Benefits for patients

  • Fewer surgery visits needed to make, cancel, or reschedule Appointments
  • Fewer telephone calls to make, cancel or reschedule Appointments, reducing the frustrations of lengthy call waiting times
  • Ease of use and convenience with 24/7 access
  • Choice of clinician
  • Online services can be helpful to people with reduced mobility, sensory difficulties or learning difficulties
  • Patients can access the service through the NHS App, other commercial providers of Apps, and the practice website, using a smartphone, tablet, or computer
  • People with proxy access can book Appointments on a patient’s behalf which is useful if support is needed for a patient to attend an Appointment
  • Patients may be able to choose whether a face-to-face or telephone Appointment is the most Appropriate enabling flexibility to fit around their schedules
  • Patients can check their Appointment details in the online portal, reducing the potential for missed Appointments and the need to reschedule

Resources

Ordering repeat prescriptions

Ordering medication online is one of the easiest ways for practices to increase uptake and usage in the NHS App and will save GP practices time as well as improve patient experience. Patients can use the NHS App, alongside practice websites and clinical systems, to view their previous orders and request a repeat prescription if the medication item is available to order. It’s a completely free service which is quick, easy, and convenient for patients. When a patient selects a repeat prescription request, it is sent directly to the surgery for sign-off and then issued directly to the nominated pharmacy. Orders can be made at any time at a patient’s convenience, they don’t have to wait for surgery to open. Once they have placed an order, patients can view their repeat prescriptions status and history, including when an item was last ordered. Across the SE Region over 51% of patients are enabled to order medication online, yet only 11% of patients order online in any month (Sept 2023), so that is a real opportunity to help people to self-serve when ordering medication. GP practices can also consider ordering medication by Proxy Care homes, doing this can smooth the medication ordering process for residents in care, again adding safety and saving time.  A website Prescriptions page should include:

Benefits for GP practices

  • Prescription requests come through fewer incoming channels
  • Improves medication safety as patients can only order what is Approved for prescription
  • Saves time, reduced phone calls

Benefits for patients

Convenience: Online prescription ordering allows patients to request and receive their medications from the comfort of their own homes, without needing to travel to the GP practice or wait on hold on the phone to check the status of repeat orders.

Time-saving: Without needing to call the GP practice during business hours, patients can submit their prescription requests at any time, day or night. This can save time and effort, particularly for patients who have busy schedules or mobility issues.

Reduced errors: When patients submit their prescription requests online, they can review the information they’ve entered before submitting it, which can help reduce errors and ensure that the correct medications are ordered.

Improved accuracy: By having patients enter their own prescription requests online, GP practice staff may be able to spend more time verifying and double-checking the information, which can help improve accuracy and reduce the risk of medication errors.

Increased efficiency: Online prescription ordering may allow GP practice staff to process and fulfil prescription requests more quickly and efficiently, which can benefit both patients and staff. Additionally, it may free up staff time to focus on other tasks, such as patient care or administrative duties.

Resources

Online consultation, video consultation

Primary care now has a lot of experience of remote consulting, and many areas are at the point of re-procuring new online consulting systems, as contracts are coming to an end and new products are available on the market. Some products offer a combined solution including telephony, online and video consultation options with messaging features and a simpler workflow and integration with clinical systems, offering practices a choice of solutions to meet changing needs. The recently updated Good practice guidelines for GP electronic records include a section on Remote consulting following detailed research into the benefits and potential pitfalls. Dealing with increasing demand for online consultations can help GP practices, who are experiencing more demand than anticipated, to plan and prepare.

Whilst 1-1 video consulting may have reduced since the pandemic, video consulting in groups also offers an alternative model for care delivery and can support the primary care workforce to care more holistically, whilst still achieving Quality and Outcomes Frameworks (QOF) targets.

Online consultation and video consultation is a useful tool for primary care and allows patients to access healthcare services from the comfort of their own homes, without the need to travel to a medical facility. This can be particularly helpful for patients with mobility issues, or who live in remote areas.

Patient feedback is high and clinicians who deliver this way also report high levels of satisfaction. Future NHS has a Video Group Clinics workspace containing case studies, guides, videos etc and provides ideas on how to do this and learn from to growing community of practitioners.

Implementing remote consulting tools effectively can also benefit practices:

  • increasing the amount of high-quality clinical information gathered before an Appointment
  • ability to complete consultations via online messaging tools and increasing efficiencies
  • improving demand management for patient requests
  • opportunities for remote working or hybrid working
  • provide clinical staff with a higher level of control over the workload
  • new channels to reach and contact patients for acute and ongoing care delivery
  • freeing up telephone capacity for patients calling into the practice
  • more Appropriate use of services within primary care
  • cost efficiencies for practices and primary care networks

Benefits for patients:

  • increased choice and flexibility when accessing care
  • new communication channels to contact the practice
  • ability to receive healthcare from their home or office
  • increasing flexibility of Appointment times
  • improving access for issues patients find difficult to discuss in person or on the phone
  • improving access for patients with barriers imposed by poor mobility or distance
  • improving access for vulnerable groups or those with difficulties with social interaction
  • improving self-care for minor ailments and management of long-term conditions
  • Is there also a benefit to patients about learning from peers with similar conditions and potentially realising they are “not the only one”?

Finally, online video consultations can help to reduce the spread of infectious diseases, as patients with symptoms can be assessed remotely, without the need to come into contact with other patients. Overall, online video consultations have the potential to revolutionise the way that healthcare services are delivered, making them more accessible, efficient and safe for patients.

Resources

Booking COVID-19 and Flu vaccinations

A total of 11.7 million people in England have had the flu vaccine so far, with 8.6 million taking up the COVID-19 booster, but millions more in vulnerable groups remain at risk. During Flu season GP practices can make the most of the national booking system for covid and flu vaccinations to help patients to keep protected against winter illnesses. The National flu booking system can still be attached to GP practice website pages under clinics and services, to provide patients with details of eligibility and also share information about the wider vaccination programmes.   GP practices can also add local details where patients can self-book online. The book or manage a COVID-19 vaccination Appointment system allows patients to book their COVID-19 vaccine at Appropriate times of the year and provides patients with details of a range of methods to access this service. The seasonal vaccinations and winter health webpage contains more details of who’s most at risk in winter, how to look on vulnerable neighbours and relatives, information leaflets, video, audio files in alternative languages that can be uploaded to a GP practice website. The UKHSA have also created easy-read to reach vulnerable patients.

Find out more about getting a COVID-19 vaccine Public Facing Campaign 2024 is available for GP practices and community pharmacies, covering a range of things that could be done, if not already, to help improve the uptake of flu and COVID-19 vaccinations this season, including quick links to available posters, digital screens, social media assets and much more.

Benefits for GP practices

  • booking online directly, saves time.
  • maximise QOF & DES income.
  • protects the  workforce
  • reduces winter pressure for Appointments

Benefits for patients

Reduces a patient’s risk of getting sick with winter illnesses. This is particularly important for those vulnerable groups who struggle the most with being unwell such as those aged 65 and over, people with long-term conditions and people who are pregnant for more info on who can get Flu and COVID-19 vaccines visit the eligibility guidance on NHS.UK. In addition to this, reducing the number of illnesses due to preventable diseases frees up NHS resources for other medical uses.

Getting a vaccine can also help a person prevent themselves from transmitting this disease to others, including those who provide care to them. This is why children, carers and health and social workers are also eligible for the vaccine.

Sometimes patients have concerns over the safety of vaccines and patients and GP practices can find more info on the safety and risk of getting these vaccines by visiting the NHS. UK COVID-19 and Flu vaccine pages.

Resources

Messaging – SMS, NHS App, Data Message, Secure Messages