Digital transformation has been a long-term strategic goal for the NHS, even before the outbreak of COVID19. The pandemic has accelerated the shift to online and telephone appointments to help manage infection risks whilst still caring for millions of people.
Whilst the changes worked for many, the reduction in in-person consultations has left others struggling to access the care they need. Among those affected are often the most vulnerable in our society: older people, disabled people, people on low incomes, and those whose first language isn't English.
NHS England has recently issued new guidance to GP practices to facilitate face-to-face appointments for patients. The move also looks to retain some of the advantages of remote care as the sector looks to find the right balance for the future.
Undoubtedly, digital and remote methods will play an increasingly important role in how people access care going forwards. To ensure that no one is left behind, we need to do everything possible to reduce barriers to accessing care remotely while giving people the agency to decide what kind of appointment is right for them.
About the report
The report by Healthwatch England, investigates the barriers to accessing digital and remote care, drawing on the experiences of people who experienced digital exclusion during the pandemic.
- 86 patients and 26 members of primary care staff.
- 34 older people aged between 60-89 years old.
- 31 disabled people.
- 21 people who experienced language barriers.
- More than a quarter of the people we spoke to were from a minority ethnic background.
Healthwatch England recommendations for post-COVID-19 digital healthcare
Healthwatch England has made five principles for digital healthcare.
The report points to the need for a bold programme of investment in digital literacy and online access while emphasising the importance of maintaining face-to-face methods to ensure no one falls through the gaps.
- Maintain traditional models of care alongside remote methods and support patients to choose the most appropriate appointment type to meet their needs
Practices should respect patient's preferences for face-to-face care unless there are good reasons to the contrary. Giving people the agency to say what is right for them is not about giving people what they 'want' but a vital way for the system to manage people's varying needs more effectively.
As we move out of the pandemic, the NHS must support the effective and safe use of remote consultations and different triage models while offering a mix of remote and in-person appointments. This would be based on shared decision-making between GPs and patients.
- Invest in support programmes to give as many people as possible the skills to access remote care
While not everyone will have the capacity or desire to access remote or digital care, we know that the proper training and support can help people who were previously digitally excluded from getting online.
The NHS must commit to improving digital literacy as part of its post-pandemic recovery strategy.
- Clarify patients' rights regarding remote care, ensuring people with support or access needs are not disadvantaged when accessing care remotely
NHS England should develop a code of practice clarifying patients' rights to receive services online or offline, alongside the kind of support they are entitled to both on and offline, like access to an interpreter. Ultimately, this should become a core part of the NHS Constitution.
More broadly, NHS England should produce a single vision statement setting out national expectations for the role remote care plays in transitioning out of the pandemic.
4. Enable practices to be proactive about inclusion by recording people's support needs
The healthcare system must understand people's individual support needs. This will be essential in removing all barriers to accessing services.
In their research, both patients and staff suggested that practices should code patient records with information regarding a patient's language, communication needs and level of digital skills. Staff can then be proactive about offering people an appropriate consultation type or pre-empt requests for adjustments in future.
5. Commit to digital inclusion by treating the internet as a universal right
In its report 'Beyond Digital', the House of Lords Covid-19 Committee recommends that the Government consider introducing a legal right to internet access, giving people a ringfenced benefits entitlement to access affordable internet.
Indeed, the national ambition to provide digital-first primary care to everyone should be underpinned by a universal right to internet access, ensuring the NHS remains genuinely free at the point of use.
Does this sound familiar? What's your story?
If you, or someone you know, has found it difficult to get GP care during the pandemic, then we want to hear from you. Tell us what made it difficult.
Maybe online appointments work for you. We want to hear that too.