There is no one-size-fits-all approach to promoting online services in general practice.  To provide effective, efficient and equitable care, practices should follow the principles of ‘inclusive access’.  This ensures patients know that they can access care and advice online, on the phone and in person, and that their care will be provided in the most appropriate way, regardless of the method they choose for first contact. 

Practices must also ensure that the services provided online are safe and secure, and that they meet the needs of their patients.

The range of online services available

The range of available online services for patients has expanded rapidly in recent years and now includes the following:

• signposting and self-care
• repeat prescription ordering
• direct booking and cancellation for certain appointments with healthcare professionals
• seeing parts of the health record, including information about medicines, vaccinations, test results and communications between the practice and other services
• viewing the medical record
• updating personal demographics online
• text messaging
• online requests for care or advice
• home monitoring

Access to transactional services (appointment booking and cancellation and repeat prescription ordering) via on an online system has been offered to patients since 2015, when it became a contractual requirement for GP practices in England.  Access to full patient records has been included in the GMS contract for GP practices since 2019. 

The ability to send an online request for care or advice has also been available for several years, more recently made further available due to the Covid-19 pandemic.

It was further defined in the GMS contract from October 2021: ‘All practices must offer and promote to patients the ability to access and use an online consultation tool’.  There are other articles in this series on online/video and remote consultations.

A joined-up approach

The NHS Long Term Plan provided every patient with the right to access digital first primary care by 2023/24.  A stepwise implementation of this is being supported by the five-year programme of updates to the GP contract, published in 2019.  These developments ensure all patients are able to access care in the most appropriate way for them, regardless of who they are or where they live.

Patients contacting the practice online for care or advice (the so-called ‘click-first’ approach) should expect to have their request addressed in the same safe and timely way as if they had walked in or phoned the practice.

Although online services provide an additional channel for patients to contact the practice and engage with their care, they are most beneficial when they feed into a common approach available for all patients.  Practices can use the following checklist whenever introducing or updating a service or pathway:

• Is it clear to patients and staff how to do this digitally?
• Does each step of the patient journey or the admin process work seamlessly with the next step?
• Are there any steps in our process which unnecessarily require non-digital contact?
• Do we respond to digital contacts in a timely way, rather than running a two-tier approach?
• Which aspects of this process could be supported by templates that ensure all important information has been gathered?
• Are we ensuring our digital services are offered and promoted without bias or assuming that some patient groups will not want to use them?
• How can we ensure patients’ digital experience is good enough that they will choose digital first next time?
• A toolkit on inclusive access has been produced by NHS England, to guide practices in reviewing or updating their joined-up approach for access.

Benefits of online patient services

Online GP services offer a wide range of benefits for patients and practices.  These include:

• Patient empowerment | Having access to comprehensive information about their health and care makes it easier for patients to understand and contribute to improving their health and any specific conditions. Patients with full access to their GP record, with signposting to relevant online information and support, are more likely to keep to recommended management plans for long-term conditions.  Patients are now able to walk in, phone in or ask for help and advice at a time that’s convenient for them, reducing the negative impact of having to take time away from work and other responsibilities.  Online services like online consultations and full records access also help patients and clinicians to be better prepared for consultations.
• Support for carers | Carers often find it difficult to take time out to bring patients to the practice or to wait on the phone. A wide range of online services make it easier for carers to arrange timely consultations and stay up to date with tests and referrals.  This makes it easier for carers to support the patient, including ensuring they receive the right care at the right time. It can also reduce the burden of caring, improving quality of life for the carer.
• Improved communication | Online consultation requests allow patients and carers to take their time in expressing themselves, increasing the likelihood that they share all relevant information with the clinician. This can be particularly helpful for people who need help with the English language.
• Sharing information | Online records access also allows patients to share information and decisions more effectively with healthcare staff.
• Workload management | Practices see reduced demands on administrative staff when patients can undertake some transactions online and to find the latest information about tests or referrals directly from reading their record. Pressure on GP appointments can be reduced when patient contacts are sorted and signposted at reception to ensure the request goes to the right person in the practice.  Some presentations are quicker to address online than in a fixed-length face to face appointment, and when used appropriately this contributes to releasing clinician time for more complex needs.
• Quality and safety of care | Managing repeat prescriptions via digital tools reduces the risk of prescribing errors. Online consultation requests make it easier for some patients with certain symptoms or concerns about stigma to provide full and accurate information about their symptoms than walking in or phoning into the practice.
• More proactive complex care | Video consultations and remote monitoring (for example, blood pressure, weight, and peak flow) make it easier to ensure patients with complex needs are monitored appropriately, without them needing to travel to the practice or request a home visit as often. This can also have a significant benefit for housebound patients and care home residents.  Clinicians can use text messaging services to quickly provide proactive prompts to patients about ongoing care, increasing adherence to management plans.

Figure 1: Summary of potential benefits for patients and practices

The benefits of online services are only fully realised when practices maximise patient usage and optimise their own ways of working.  What follows is practical guidance about doing this.

Informing patients

Practices have several opportunities to inform patients about their online service options and how to make the best use of them.  Promoting an inclusive access mindset can underpin all aspects of how the practice offers its services. 

It is worth having an intentional plan for maximising the impact of the information provided, and to take a regular review of how successful it is.  Patients should be reassured that they can also contact the practice on the phone and in person.

NHS England has produced a detailed guide on communicating with patients about the range of ways they can access care.

Improving patients’ awareness and providing targeted support can have a significant impact.  One GP practice, The Swan in Buckinghamshire, held a targeted campaign to increase online registration for transactional services and successfully signed up 1,200 additional patients.  They found daily telephone calls requesting test results were halved from 50 calls per day to 25 providing an extra 75 minutes per day / 6 hours and 25 minutes per week to divert to other duties.

Ways of promoting online services

Practices have a range of opportunities for promoting online services to patients:

• In the building | Practices can place information about online services in prominent places within the surgery building. The UK Health Security Agency has produced downloadable promotional materials which are free for practices to use.
• Practice website | Make sure your online services are clearly accessible on the practice website. Up-to-date guidance is available in the NHS Digital Service Manual.  Most general practice website providers are experienced in this, but it is also helpful to seek feedback from your own patients about any improvements that could be made, such as making more prominent use of video information and translations in other languages.  NHS England’s digital primary care team recommends practices pay particular attention to these tips:
  • ensure banners and links to online consultation requests appear in the correct place on mobile devices as well as laptops, as not all websites are properly optimized for mobile devices
  • make it clear that an ‘online consultation’ feature is a means to send a request to the practice – user testing shows that patients often think it will take them directly into a video consultation
  • provide prominent links to services that address patients’ most common reasons for using your online services. An audit at one inner city practice showed these were fit note request, register for online services, travel risk assessment, new patient registration, contact the practice, ask reception a question, and change of name or address.

This generally involves having a large banner link near the top of the front page, as well as presenting direct links to online services as one of the first options in each relevant section of the site (e.g., appointments, repeat prescriptions, test results).

• In the practice newsletter | Many practices provide a regular reminder about their online services in the practice newsletter for patients. Use can be further encouraged by including stories from patients themselves about their experience, and ways to make the most of these services.
• In regular communications | Links to online services can be included in regular communications sent to patients. For example, all letters to patients could include direct links to popular sections on the website, and review reminders could encourage using an online consultation proforma as the first option.
• In phone messages | Information can be included on the phone system, with consideration of ways to avoid every patient having to listen to a lengthy message every time they call the practice. Many practices have found messages like this are most effective when recorded by a well-known GP in the practice.
• On social media | It is increasingly common for practices to use social media to connect with patients and this can be an effective way to encourage greater use of online services. Practices can share information about their range of services and can share specific links to information and login pages.  It is particularly effective to make use of topical events, such as winter, or major holidays, and to share information relevant to health stories in the news.  If you have staff who use social media in a professional capacity, it is helpful to encourage them to share your messages too, and to encourage other local figures such as local politicians and media to follow you and share important messages.
• At registration | The best time to register patients for online services may be when they register with the practice. This is also an opportunity to provide information about the range of services available and how to access them.  The practice may wish to include online services registration as a default part of the process for registering with the practice, with the option for the patient to opt out.  Staff who regularly deal with patient registration should be confident in explaining the benefits of online services and to answer common questions.
• For specific groups | Practices will often have specific groups of patients who could be sent targeted information and support to raise their awareness and confidence to use online services. This might include patients who do not attend booked appointments or those who are overdue a review of an ongoing condition, for whom online services may make it easier to stay up to date with their care.  It might also be necessary to reach out with tailored information and support to patients with limited digital skills.

Supporting patients

Practices can supplement information with direct support for patients, which will often be particularly helpful by addressing a specific need the patient has presented with.

At reception

It is essential that all staff in the practice are knowledgeable about the range of online services available to your patients, and confident in explaining the benefits and practicalities.  This should include being able to reassure patients that they will receive appropriate care regardless of the channel they use for accessing the practice.  It is also worth having information available regarding local support to increase digital literacy.

Practices can use the opportunity of special clinics to engage with larger groups of patients.  A member of staff could, for example, be on hand at vaccination clinics, baby clinics, and group consultations to provide information, register patients and demonstrate particular services.

Staff training

It is important to provide training for all staff, and this should include an opportunity for them to try out the services themselves and to ask questions, as well as to know how to ensure all patients receive inclusive access regardless of their needs.  Regular refresher sessions will also help and allow staff to feedback about additional opportunities they have spotted for maximising the benefits.  Reception staff, in particular, will often hear feedback from patients about this.

Training for reception and admin staff should help them know about the full range of online services, how to support patients to make best use of them, and how to process digital workflows themselves.  Training is available from the suppliers of online consultation systems as well as other specialist training providers. 

A typical training or refresher session could include the following:

• Why offer online services? Review and discussion of the benefits for patients, carers, and the practice.  Staff could talk about their own experiences, or watch videos such as these from NHS England:
  • The receptionist’s experience
  • The patient’s experience
  • Benefits of full text records access
  • Benefits for ongoing care
  • Patients sharing their information more easily
• How to promote online services to patients? Guided practice to increase the confidence of staff to introduce different online services, explain their benefits for patients and answer common questions. A role play approach with group discussion can help to develop skills and address any concerns staff may have.
• Opportunities to improve. Staff will often have unique insights into ways that the practice could make more effective use of online services.  A regular refresher session is a good opportunity to ask for feedback on this.  Suggestions commonly include new ideas about promoting and explaining options to patients, and ways to process digital workflows safely and efficiently.  Reception and clerical staff may have witnessed specific issues for certain patient groups, and their insights into these should be sought on a regular basis.

In consultations

Clinicians often have opportunities in consultations to promote greater use of online services to patients and their carers.  Three commonly used approaches are:

• offer to provide the patient with information about conditions and treatments via text message rather than on paper
• promote the use of online consultation requests for follow-up care, to make it easier for the practice to direct the request to the right person
• demonstrate the usefulness of online records access by showing the patient their record in the consultation and where to find key pieces of relevant information such as their forthcoming test results

As part of social prescribing and care navigation

Social prescribing link workers and care navigators are often ideally placed to raise awareness and confidence for patients to make best use of online services.  This can have the dual benefit of improving the way they are supported with a specific medical need and increasing their social capital in general. 

Link workers may be able to demonstrate the information, communities and services that are available to a patient, and also to signpost them to local training for digital and English language skills such as through the Online Centres Network or Age UK. More information about digital inclusion is available in other guidelines in this series.

Primary care networks (PCNs) are increasingly exploring ways to address local health inequalities.  This may be supported by efforts to increase patients’ confidence to use online health services, with the PCN and local voluntary sector organisations collaborating to provide relevant advocacy and training.

From patients

Some practices have involved their patient participation group (PPG) in promoting online services.  You could use your PPG members to:

• contribute to the design of new services or pathways, for example for specific groups such as carers and people with long-term conditions
• trial online services alongside practice staff, allowing for a better understanding of how it can help patients
• provide an ‘information point’ where people can find out more about online services and how to access and use them
• ensure practice staff also know about other sources of support in the area
• write a post about using the online services on the practice website or social media pages

Watch this video for ideas from one practice that has worked closely with its PPG to encourage more patients to use online services.

Optimise your processes

In addition to informing and supporting patients, practices can maximise the use of online services by ensuring patients have confidence that they are an effective and safe way to access care.  Positive information may not overcome a poor experience. Conversely, word of mouth from patients who have had a positive experience can be one of the most effective promoters of use.  Tips to address common issues include:

• test a digital workflow with different patient scenarios until you are happy it works
• ensure digital contacts are dealt with in the same timely fashion as other contacts
• include training and clear protocols so that receptionists can direct contacts to the most appropriate person first time
• ensure digital workflows are reliable so that tasks do not get overlooked or ‘lost in the system’
• provide clarity for patients about what will happen next after they submit an online contact
• check that the technical aspects of video consultations work smoothly in each consulting room and that all relevant staff are confident in using the hardware and software involved

Practices can seek feedback from patients and staff about ways they could improve the experience of online services and thus increase patients’ willingness to use them.

Related GPG content

• NHS login
• NHS App
• Identity (ID) verification
• Practice websites
• Health equalities and inclusion
• Digital skills for patients
• Patients updating personal details online
• Primary Care Networks (PCNs)
• Online repeat prescriptions
• Video consultation tools
• GP contract