Notes: Patient Online Workshop: Hackney– 21 November

15 participants attended the workshop including 4 practice staff and someone involved in the MyRecord Lewisham pilot. 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 had a plenary discussion to share ideas about future patient involvement in the programme. 15 participants attended the workshop including 4 practice staff and someone involved in the MyRecord Lewisham pilot. 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 had a plenary discussion to share ideas about future patient involvement in the programme. Attendance and format Patient Online Workshop – Hackney event – 21 November 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 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 Objectives for the Workshop

Q) It is a big challenge and you need to consider that there are people who are not able to have access to the Internet. How would you deal with that? A) 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. 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. However, this will not replace the traditional ways of accessing information and making appointments, so these methods will still be available. Q) I am a practice manager and I am worried about the POL programme. I am afraid the online access won’t be helpful for patients and for GP practices since that we have little information on the online system. A) NHS England is working on a programme of training and support for GP practices to support Patient Online Q) Is this implementation going to be funded? If so, how much would it be? We don’t have enough money, no doctors and few staff. A) The IT systems that support Patient Online are being centrally funded so there is no cost to individual GP practices. In addition, one of the goals of the programme is to reduce pressure on practice staff e.g. from dealing with phone calls. Q) Through the online system people could check their results before their GP has seen it. What if a patient is HIV positive and finds it online when he/she is on his own? A) In some cases test results might not be appropriate to share online – the patient would be asked to call to discuss with a doctor or nurse. Q) Does Patient Online mean that a private companies will have access to our medical records? Information regarding patient’s health are valuable to insurers. A) Patients will be able to decide what to put online. They will have control of their health records and would be free to share (or not) those with 3 rd parties to assist in delivery of their care. 3 Q&A

Q) Can you explain what the electronic communication with GP is about? A) Patients who wish to will be able to send electronic messages to their clinicians. Some GPs already their patients: we are constantly checking security issues for patients, but if patients are happy to do this, it can enhance communication. This area might also include new ways to have consultations, eg via Skype. Q) Are there studies that prove that these services will reduce workflow and improve efficiency? Because the more access we give, the more demanding people will be. A) Yes, there is evidence that online transactions improve efficiencies, hence the reason they have been introduced across so many industries such as travel, retail and banking. E.g. patients with diabetes need to check their results more often and they are keener in checking their records all the time. Q) I had a huge hassle with EMIS: when I tried to book an appointment online, my surgery didn’t exist and the system didn’t let me sign in because I didn’t put my mobile number (I never use it, except for emergencies). A) We are changing and improving EMIS so that the system will meet the need and the requirements of our patients, and will be much ‘friendlier’ to use. Other concerns raised included: Whether locums would know how to use these systems Would this be accessible for patients from different ethnic groups Would it unleash huge demand from patients wanting to correct past records How will the interests of vulnerable patients be safeguarded, for example those experiencing domestic violence How will you overcome objections from Medical Protection Society who have said it is not acceptable to text test results to patients 4 Q&A

Cost of telephone to the practice is enormous Online appointment booking is a god send Having online appointment cancellation and booking has improved the ‘no shows’ This is exactly what I want (a patient) Used to not be able to get through on the phone – now can use online to make or cancel appointment Text message reminders of appointments are really good. This is about the collective ‘us’, we are in it together, not helpful to talk as if it is us and them [patient] Systems must be easy to use for it [patient access] to work Confusing for patient (and staff) so many websites: My London, GPPractice website, NHS Choices Need to be able to book more than one appointment (current system apparently limits patient to one appointment only) Why do I have to tell the system my mobile number ? I don’t use my mobile except for emergencies. May depend on demographics, patient access may suit some people better 5 Current experience of online services in primary care

Why are patients always expected to volunteer? At the very least expenses should be paid. I would have concerns about championing something that is a choice for people. Don’t want to evangelise NHS England should lead this so that it is consistent. It shouldn’t be left to practices to do. We can advertise in the surgery with posters or notices or the practice newsletter. Printed word still important. We can advertise via messages on prescriptions 6 Ways of working together and helping to make things happen

7 You cannot assume: a) patients have home computers, are computer literate, use a computer on a daily basis for a range of aspects of their daily lives, so that an online patient website would be a place they would easily visit regularly, and b) patients are keen to take more responsibility for their health care. Both are big assumptions and a discussion of how online services will affect, let alone benefit, patients who fit neither assumption, needs to be considered, in my view. That is, to ensure that these new moves leave no one out. Repeat prescriptions are an easy way to make life easier for GPs. Getting test results may not be so simple. A positive test result for something may need to lead to further tests or treatment, a hospital appointment, etc. How to convey this to patients in their notes in such a way that the doctor doesn’t lose sight of them and the patient is neither frightened nor unaware of what next steps should be – both are important. Will the patient still get a phone call or letter, for example? Booking appointments would be great as long as the patients can tick a date and time in a calendar-type grid and the appointment is duly accepted. What if there ends up being a mix of the old system of phone calls and the online system? Will that make less work? Will patients have to go online more than once to get an appointment when they want and can manage, as we currently do by phone? Having to go back online may end up being more of a pain than phoning more than once, because computers may not be left on all day. Under current status in the background document, it would be useful to know why half of practices have utilised two of the 4 aspects but almost none the other two. Also, which practices do these data cover? Bids for the work on the contract to supply services. Can we opt for an NHS supplier for City & Hackney, please, just as we did the OOH services? I would suggest someone to look into health education messages and health promotion by computer. Lastly, for the sake of young people, I think it’s crucial to include access via cellphones and tablets, not just computers. Appendix – written feedback from patient unable to attend

8 NHS England, HSCIC and NAPP welcome patient participation in the Patient Online programme. If you would like to find out more, please contact: Frances Newell NHS England, HSCIC and NAPP welcome patient participation in the Patient Online programme. If you would like to find out more, please contact: Frances Newell Want to know more about Patient Online?