Who is this guide for?
This guide is for healthcare staff in general practices, primary care networks (PCNs), integrated care systems (ICSs) and anyone else who is seeking to reduce digital exclusion in general practice, particularly among under-served and marginalised communities. It has been produced by Good Things Foundation (a digital inclusion charity) and NHS England’s Primary Care Transformation Programme, supported by the Voluntary, Community, and Social Enterprise Health and Wellbeing Alliance. It draws on examples of good practice shared by over 30 primary care organisations and voluntary community and social enterprise (VCSE) organisations in England. More detailed case studies are available on Good Things Foundation’s website.
What is digital inclusion?
For NHS patients, digital inclusion means having easy and affordable access to a suitable device with sufficient data and internet connectivity, and the digital skills and health literacy to use them safely and confidently to access NHS services.
Around 1 in 20 UK households still do not have access to the internet (Ofcom, 2022), and around 10 million adults lack basic digital skills (Lloyds Banking Group, 2022). Limited internet use is associated with economic deprivation: those who do not frequently use the internet are 4 times more likely to be from low income households than those who do so extensively (Yates, 2022). Offering support to patients who struggle to use digital tools will help prevent further widening of health inequalities.
You can find out more about digital exclusion and the potential mitigations in this resource from Good Things Foundation: Health inequalities and mitigating risks of digital exclusion.
Tips for making digital access more inclusive
We have identified 10 ‘top tips’ for making digital access more inclusive, especially for those in under-served communities and socially excluded groups. However, there is no one-size fits all solution and you will need to invest time to find out what works best in your area. Case studies are available on the Good Things Foundation’s website.
Identify demographic groups who are at higher risk of digital exclusion. Integrated care board (ICB) leads could identify those in their footprint who are most likely to be digitally excluded, using insights from local joint strategic needs assessments and tools such as the Digital Exclusion Risk Index and the Core20PLUS5 approach to reducing healthcare inequalities. As already mentioned, digital exclusion is associated with deprivation (Yates, 2022) and therefore identifying the areas of highest deprivation will help identify patients at risk of digital exclusion. The local authority or local VCSE organisations may be able to provide local information. Where PCNs have a digital and transformation lead, they may help identify the local cohorts of patients who are likely to require support, drawing on an analysis of practices’ data.
Co-design support offers with patients. ICBs should co-design support with patients who struggle with digital access or skills as this helps identify specific barriers and what should be offered to overcome these. Co-design could involve setting up a focus group, partnering with local community organisations or asking local patient participation groups to help. Diversity and inclusivity need to be considered when engaging with patients, to ensure people who face barriers to digital use (related to confidence, device availability or data connectivity) are included: if an offer works for them, it is likely to work for most patients. Patient feedback needs to be collected at regular intervals and acted on to keep improving.
Ensure website pages and digital tools are usable and accessible. GP practices need to make their websites highly accessible and usable so as many patients as possible can find what they need quickly and easily. If a patient has a good experience using the website, they will be more likely to use it again. ICBs could lead improvement work in their footprint to make practice websites more usable and accessible. The NHS England guidance Creating a highly accessible and usable GP website provides user-tested advice; a summary of the requirements for general practices; templates to make changes easy; and guidance on how and where to get specialist advice on testing and improving the usability, accessibility and inclusivity of websites. The GP website benchmarking and improvement tool can help ICSs, PCNs and general practices audit and benchmark the usability of GP websites.
Use multiple communication routes to tell patients about support offers. Use different channels and community languages to inform patients how they can get help to use digital tools (for example, accessible leaflets, radio, social media, direct targeting by phone, text or email). Communicate the benefits of using digital tools – for them, and also for other patients and staff. Inclusive access routes to general practice is a tested toolkit of communication materials, available free from the national Campaign Resource Centre.
Always provide choice. When offering patients support to use digital tools or access routes, make it clear to them that they can continue to telephone or visit the surgery to request care. This will allay fears that some options are being withdrawn. Patients may also need support to build their trust in digital tools, something that administrative staff can help with. The free e-learning module administrative triage using digital tools includes examples of how staff can explain digital access to patients.
Continue to offer support to patients who decline it the first time. Their views and needs may change, and some may want support at a later date, when they have more time or feel more confident. However, when patients make it clear that they do not want to consider using digital tools, reassure them that they can continue to use their preferred access route, and record and follow their preferences.
Offer patients and carers a variety of ways to get support with digital access and skills. Find out what support is available in your area and signpost patients to available offers; for example, in the practice, at home or in local community settings, such as a local library. Signpost patients to community services that help build digital skills, even if they are not health related. Skills for Life helps identify free locally available courses teaching essential digital skills. People who are supported to develop their digital skills in other aspects of their lives (such as online shopping or to access state benefits) will likely be more confident in trying out digital tools for their healthcare.
Strengthen primary care network and VCSE relationships. PCNs can play a significant role in promoting inclusive access by signposting to local VCSE organisations that provide support. ICBs could find out what support local organisations can offer and work with PCNs in their footprint to facilitate signposting to these offers.
Provide devices and data connectivity. The most digitally excluded people may not be able to use digital tools unless they are given access to a suitable device and free mobile or broadband data. Some VCSE organisations and library services provide devices and data connectivity. ICB leads should get in touch with local authorities or VCSE organisations to find out whether they offer devices or data connectivity, and explore the Good Things Foundation’s National Digital Inclusion Network (search Network Map) and National Databank to identify available support locally.
Give staff time to support patients. Allow practice staff to take the time to support patients who are learning how to use digital tools; for example, how to submit an online request or ask for a repeat prescription online. As it can take time to teach patients how to use digital tools, staff need to know they are permitted to use their time in this way.
Appoint and train digital inclusion champions. Digital inclusion is easier to embed when there is leadership commitment and ownership by staff. Recruiting digital champions among staff can help make digital inclusion part of your practice’s business as usual. For example, digital inclusion champions can take the lead on supporting patients to use digital tools safely and confidently, and can advise their colleagues on how best to promote them. For more resources and to join our community visit our webpages.
Further information and resources
- NHS England (2023) Inclusive digital healthcare: a framework for NHS action on digital inclusion
- Digital Unite Digital Health Champions Network
- elearning for healthcare and NHS England (2022) Administrative triage using digital tools in general practice (free e-learning for practice staff, which includes an introduction to administrative triage and signposting, and advice on designing and promoting inclusive services for patients)
- Good Things Foundation (2022) Digital inclusion in health and care: Lessons learned from NHS Widening Digital Participation programme
- Good Things Foundation (2022) Health inequalities and mitigating risks of digital exclusion (includes a long list of useful research and resources)
- Greater Manchester Combined Authority Digital Exclusion Risk Index tool
- HM Government Skills for Life Campaign
- Lloyds Banking Group (2022) UK Consumer Digital Index report 2022
- NHS Digital (2019) Digital inclusion for health and social care
- NHS England (2023) General practice access routes (free campaign resources that help practice teams explain the 3 ways patients can request care – requires login)
- NHS England (2023) GP website benchmarking and improvement tool
- NHS England (2022) Creating a highly usable and accessible GP website for patients
- NHS England (2022) Working in partnership with people and communities: statutory guidance
- NHS England (2021) Core20PLUS5
- NHS England (2020) Advice on how to establish a remote ‘total triage’ model in general practice using online consultations
- NHS England (2019) Online consultations implementation toolkit
- Ofcom (2022) Adults’ media use and attitudes report 2022
- Yates S (2022) Types of UK internet users, analysis of Ofcom 2022 data on internet use by adults. In: Digital Nation UK 2022
- WSA Community Consultants (2020) Digital health hubs evaluation
Publication reference: PRN00062