Notes: Patient Online Workshop: Crewe – 27 November 2013

1. Notes: Patient Online Workshop: Crewe – 27 November 2013

2. Patient Online Workshop – Crewe events – 27 November 2013 Objectives for the Workshop • The workshop was one of two organised in partnership with the National Association for Patient Participation (N.A.P.P.). Objectives were to: • understand patient experience of the online services that already exist in GP practices; • share and develop ideas on how patients can get involved in implementation of Patient Online, including looking at the potential role of Patient Participation Groups (PPGs); • discuss how best to develop patient champions and advocates across England to encourage wider take-up of these services; and • seek views on how to communicate about the aims and benefits of Patient Online 30 participants attended the workshop. After an introduction to the Patient Online programme (POL), patients had the chance to voice their questions during the Q&A Session. Attendees shared current experience of online services with their GP practices, and then participated in a group exercise, which allowed them to discuss the potential benefits of the Patient Online: appointments booking, secure electronic communication between patients and practices, repeat prescriptions, and access to patients records. Finally, patients worked in groups to generate ideas for patient involvement in Patient Online. The attendees concluded that the event provided a good opportunity for networking and significantly increased their knowledge of the Patient Online programme. Participants’ quotes are captured on slide 15. Attendance and format

3. Q&A 1) Will the Patient Online programme have cost implication for GP Practices? If so, how much would it be? Many Practices have already introduced online services. The online services (appointment booking, repeat prescriptions, access to test results, and records), will improve during 2014/15 (go live April 2014) with the introduction of the revised GP System of Choice framework, which will be centrally funded. And by March 2015, all practices will have the facilities to offer the above-mentioned services. There is a programme of inclusion through NHS England (working with the Tinder Foundation) to deliver training in digital skills and supported access to technology. We also know that peer support and ‘helpdesk’ type support can be very helpful in enabling people to access these types of services, so we are looking at ways to develop this as well. Yes, we would encourage surgeries to have a computer terminal where patients can log in and use the online services – a few do this already. 2) Patient Online is an additional system, and not a substitute of the current one. Have you considered that this could be hard to understand for those people who are not computer literate? 3) Will surgeries have a private area/place where people can log in?

4. Q&A 4) EMIS is a private software company - will GP practices and patients be forced to use their system? There are 5 different companies that supply computer systems used by GP Practices in the UK. However, GPs have the choice of what system they want to use (which will be centrally funded) and Practices will open up technical interfaces in order to provide services to patients. At the same time, patients will have choice about how they connect to their GP practice, using free internet and smart phone applications., Yes, but Practices will help out with regards to non IT-users, and they will actually feel much more integrated in the new system. Libraries, community facilities and internet cafes provide access to the Internet, so there are possibilities for people without computers to access online services that way, or via their phones. However, this will not replace the traditional ways of accessing information and making appointments, so these methods will still be available. 5) Patients will gain access in the first place to their personal records. What about the security system? 6) 7 Million People still do not have access to the Internet. Some of them are disadvantaged and do not have a computer, while others are just not interested in having one. I cannot see an easy solution for these cases.

5. Benefits of Patient Online from Patient Perspective Group Exercise Attendees were asked to describe the benefits of each of the main functional areas of Patient Online: I) Online Appointment Booking II) Secure electronic communication between GP Practice and Patients III) Repeatprescriptions IV) Access to patient records • Responses have been organised into three categories; • Benefit • Suggestions • Concerns/questions

6. I) Appointment Booking BENEFITS • Instant access anytime of the day or night • Actually see when a particular GP is available • It is difficult to get through the phone so online booking is great! • Easier to do appointments online than wait in a queue on the phone • Time and money saving SUGGESTIONS • Commence system between Hospitals and GPs • Make sure non IT- Patients have equal access on the phone • In order to register, you have to complete a form and return to the practice two days later to pick up the “password” presumably to prove who you are • Online booking needs to work in real time with phone booking – use same system • Bookable consecutive appointments • More access for non-English speakers • Only applies if practice decides to allow this. They are variable • Confirmation that your appointment is booked • Need a simple URL to access – say www.mynhs.co.uk rather than complex ways of accessing • Surely, when you have completed the form, you should be notified direct by e-mail, and given your password that way • People do not understand how the system works, so they should be educated • Limiting number of appointments is good when patients want to see the same doctor CONCERNS/QUESTIONS • Will a percentage of appointments be available to book online, or all of them? • Our practice only gives access to appointments, not prescriptions or personal files. No advantage to register for online services • Too much demand for appointments available • What happens if more than one person books the same appointment slot? • Different GP surgeries have different appointment system/ethos. This adds confusion to patients • Challenge for surgeries • Online system doesn’t work for urgent appointments • Can only book future non-urgent appointments – need to have access to book an appointment on the same or next day too, or not worth using • Can’t book appointments far enough in advance either online or at GP surgery

7. II) Secure electronic communication between GP Practice and Patients BENEFITS • Remote access to professional advice. In own locality via IT-link • Not leaving home unless consultation required! • Saves a journey – supplements telephone appointments • Gives more flexibility • Efficient because reduces work for receptionist, saves a salary • Sorts out simple queries, e.g. prescriptions • Really accessible for deaf people • Skype is free (face-to-face) • Audit trial of your own • E-mailing photos – useful advice whether to escalate • Over expectation! How to manage? • Timely response • Tailored, appropriate health advice • Possibility of email contact out of hours • Would be useful to be able to ask questions as a follow up to a GP consultations – easy to forget at the time or think afterwards • Benefit of email if it is a secure nhs.net email • Benefit of emailing at a time for the patient that is convenient to them SUGGESTIONS • Need assurance on response time to emails • Pilot initially with non-GP clinicians! • Need assurance of consistency and timelines • Guidance on parameters and expectations – on both sides • Email contact – need one address to ensure action. Many GPs do not work 5 days a week • Good – but need guidance on when appropriate to use electronic communications and when a face-to-face is needed • NAPP meeting for Monitor. Would you prefer to see a GP of your choice? CONCERNS/QUESTIONS • Convenient for patient, but is it also convenient for practice? • Concern on GP resource to handle • Does the surgery have a capacity to cope with live communication online? Concern over “who” you are communicating with – is it your GP or a nurse in the practice, or not? • Security: what stops private organisations placing adverts on your information?

8. III) Repeatprescriptions BENEFITS • Online prescriptions are greener, less pollution • Direct access to chemist – home delivery • Emergency medicines – who has access? Patients who are not online should be given a written list of medicines, to take on holiday – to be shown in emergencies, GPs etc. • Time saving • Flexible. Amounts of meds ordered – i.e. insulin SUGGESTIONS • On-line prescriptions need work – explanatory notes for patients • Online queries: medications? • Medical review date: GP reminder • Patients on long term insulin use should be able to have at least 2 months’ supply • Repeat prescribing: a function to order current one-off items that you require, but not on a regular repeat • Local pharmacy checks monthly with patients to see if items are all needed CONCERNS/QUESTIONS • Getting the correctdrugs • No way to feedback about medicines  still need to make appointment • Consensus – too many versions of repeat prescriptions • Automatic pharmacy renewal wastes resources – tax payers’ money • Repeat prescriptions need “vetting” – some patients will order drugs they do not need monthly • Drugs on different repeat periods of time • Refusal of a repeat  patient confused?

9. IV) Access to patient records, test results etc.

10. Planning patient involvement: 1) How can we build patient awareness and demand for these services? • GPs and nurses to promote in consultations • Pharmacy staff to promote • 1:1 Discussion  talking to patient in the practice waiting room • Practice publicity: • Posters • Newsletters • Website • New patient pack • Free service (right hand pack of prescription) • Surgery Business Card: telephone number, website access • Write to or email all patients • Write to all patients who “DO NOT” attend surgery • ‘Next time you can do it online’ • Clear statement of what it is: • No jargon • Plain English • Per practice basis  different/tailored ways • Develop a partnership between the Practice and PPG • Social marketing segmentation. EgYoung person promotion – ask them for ideas on how to promote • Via professional dealing with specific groups  understanding barriers  different messages • Condition-specific websites • Patients group • Locality based messaging • Crewe area federation of PPG  April 2014: conference/networking

11. Planning patient involvement: 2) How can we support patient champions for this programme? • Ensuring given accurate information/crib sheets • Updates of changes • Part of group/network • Access to I.T. advice/support • Feedback regarding teething issues/errors • Strategic levels – two way information • Any patient that has the interest, enthusiasm and energy • Champion in each surgery • Messages must be consistent • Go via volunteer groups – e.g. Age Concern • Go via health advocates in a PPG • Who will take responsibility for information? • Which organisation will they be representing? • Use Social media / twitter • Info facilitators/know-alls patient friends • Topic for Locality/Federation of PPGs

12. Planning patient involvement: 3) How might PPGs/individual patients be involved in this programme? • Desks in practices to promote • Reception staff involved • Don’t torture ourselves to get everyone involved • Computer terminal in surgeries • Show pts through online check in • Information for leaflets, newsletters , displays in surgeries, posters • Communication: • - Systems • - Email = Do not forget system for patients not online • - Online • - Text to mobile • How to contact/engage younger fitters patients • Use virtual PPG • Use emails from PPGs • PPG could put pressure on or support practice to implement • PPG work with GP’s, staff with feedback to patients • PPGs could promote this to Individual patients and could support champions • Need to know their commitment • Practical things – paper, computer, etc. • Leaflets, hand-outs • Feedback • User acceptance testing • Using their area of interest • Targeting specific conditions • Making them aware of what is expected, so they don’t get disillusioned • Focus group involvement • Varying medical needs, interests and experiences across all demographics

13. Planning patient involvement: 4) What support would they need? • Information • Knowledge • Invited to events, conferences • Expenses • GP’s may not agree with all suggestions/choices • Communication via NAPP and other rates • Federating (on a CCG footprint) make it worth coming to it; working groups • Conferences • Mixing with people out of area • Working across boundaries • Refreshing (members change) • Stronger role of NHS England • Communication tool kit • Delivering letters in local PPG • PPG should be first to know • Email + sms • Central point of contact • PPG should be patient champions • Understanding people’s barriers • Community/Groups involvement (e.g. access skills) • Signposting Services e.g. Information prescriptions

14. Feedback on workshop organisation • Whilst the majority of respondents were satisfied with the quality and key aspects of the events, some of them commented that future events would benefit from addressing the following issues: • more NHS England/HSCIC engagement across the UK, to convey the message that patients input was valuable; • provide name badges or labels to break the ice and to start conversations among attendees; • improve the quality of power point presentations; • simplify the admin process to book on to the workshop • better use of microphones.

15. Patient Online Workshop – Crewe – 27 November 2013 General comments/ from graffiti board “There should be consistency in system – similar or same for every patient/practice” “The choice of supplier may lead to confusion amongst patients – we need one portal” “Patients need to have very easy access to the system” “Thank you for putting on a great event” “Please test the running of EMIS beforehand” Online access might not be accessible for patients where English is not first language. GP practices should have in place a toolkit and/or leaflets in appropriate languages which explain what kind of info you can access, how to do it and why. “Why is there not one system across GP Practices nationally?” “Doctors are asked to do too much on stuff that are not related to the care of patients” Want to know more about Patient Online? We welcome patient participation in the programme. For more information contact Frances Newell at NHS England; email frances.newell@nhs.net