Top tips: Supporting digital inclusion in general practice

Local care partnerships (LCPs) is the term used in Leeds to describe joined up working to deliver local care to people in partnership with communities. 100% Digital Leeds is working with some LCPs in economically deprived wards in Leeds to establish networks of Digital Health Hubs. Digital Health Hubs are trusted community organisations in key locations with supportive staff, and they offer a wide range of digital inclusion support, such as providing access to devices and data connectivity, and helping people to build their digital skills and confidence. Through workshops, network meetings, and conversations with organisations, 100% Digital Leeds and Leeds LCPs built a digital support infrastructure across local voluntary and community sector organisations. They also worked with GP practices, community healthcare, social prescribers and others to promote the offer and provide a simplified referral and signposting route.

Over 250 people were supported to access digital tools and apps (such as the NHS App) in the pilot and, due to the success of the pilot, the model is being rolled out across Leeds.

Implementation tips

• Use insights from Joint Strategic Needs Assessments, demographic data and local mapping of existing community assets – especially community and voluntary sector organisations which are valued by local people as trusted spaces.
• Link with and sell the benefits of the Digital Health Hub offer to the Primary Care Network manager: this was assessed as key to identifying staff across GP practices who may be willing to support others (staff, volunteers) to become digital champions.
• Ensure the VSCE infrastructure is in place before rolling out the offer to GP practices: this enabled 100% Leeds to produce an “at a glance guide” which admin staff could use to signpost patients to specialist organisations.
• Make use of ​schemes like the Additional Role Reimbursement Scheme to create Digital Champions within your general practice. Work closely with social prescribers and link workers. Such roles can help to ensure signposting is tailored to the needs of the patient,​ and ​that digital inclusion and health literacy needs are considered together.
• Encourage health colleagues who are supporting digital inclusion to visit community venues where patients visit: this may be more productive than approaching patients in a GP practice setting.
• Develop peer resources: a video to show the benefits of signposting to Digital Health Hubs is being produced by a local care coordinator, to ensure the information is relatable and highlights the practical, everyday benefits of the service.

The challenge

Admin staff based at busy GP practices across the Beeston and Middleton area in Leeds were unsure where to signpost vulnerable patients who required digital and non-digital support around their health needs and had limited time to offer direct support.

The approach

100% Digital Leeds developed a place-based approach to digital inclusion to improve health participation, working with Beeston and Middleton Local Care Partnership to develop a Digital Health Hub Network. Each Digital Health Hub offers accessible spaces for patients at the heart of the local community.

Funding was made available to pay for digital infrastructure such as equipment and connectivity, and staff capacity to develop and implement the project (including continuing professional development sessions twice a year). 276 staff across organisations were trained to increase awareness and understanding of the barriers to digital inclusion and how to reduce these.

GP practices were contacted at early stages. Though interested in the Digital Health Hub model, many didn’t have the time to join early conversations. The VSCE sector support was therefore put in place first to ensure the best use of GPs’ time.

Once the Digital Health Hub offer was set up, participation was achieved through gentle persistence and persuading senior practice staff that the offer would save them time. The team worked with practice receptionists, care coordinators and social prescribing staff to co-design a one-page laminated leaflet which offers “at a glance” information about Digital Health Hubs to busy practice administrative staff.

“Staff have a list of things they need to know on that day – alongside signposting to digital inclusion support…so [the leaflet] needed to be as easy and practical as possible to use and not another thing to do.”

100% Digital Leeds also linked up with the Primary Care Network manager who covers Beeston and Middleton to help recruitment of digital champions in each GP practice. Patient Participation Groups will be involved in the next phase.

Digital Health Hubs were supported through 100% Digital Leeds, which facilitated a range of cross-sector networks and provided digital inclusion training to health professionals in the city.

Joint Strategic Needs Assessments, demographic data and details of community assets such as libraries, community sector organisations and groups were used to create a solid understanding of local needs and characteristics. This helped support prioritisation and targeting of resources.

Other information

100% Digital Leeds: Supporting improved digital health participation (digitalinclusionleeds.com)

Local Care Partnerships: https://leedshcp.mixd.co.uk/about/partners/local-care-partnerships/

Digital Health Hubs: An evaluation (WSA Community Consultants 2020)

Bevan Health and Wellbeing successfully recruited and trained peer volunteers to increase digital literacy and online use of healthcare for volunteers and patients who were asylum seekers, refugees or who had been affected by homelessness. Of 77 patients who participated in an evaluation, 29% started using online consultation systems or similar website forms to request help from their GP; 26% requested repeat prescriptions online; and a quarter used a video app for GP consultations.

Implementation tips

• Support patients to develop everyday digital skills: this can boost patients’ digital confidence so they’re more likely to try online GP services.
• Ensure that a comprehensive training offer is provided to volunteers: this supports their digital confidence, making it easier for them to provide tailored support to patients.
• Work with organisations to ensure data and devices can be provided for patients who experience digital poverty.

The challenge

Bevan were concerned that the rapid increase in digital channels to access health care as a result of Covid-19 would mean that patients at risk of digital exclusion and who face other challenges would be left behind.

The approach

Bevan, a social enterprise which provides primary healthcare and wellbeing services to those who are socially excluded, ran the Smart Health Inclusion Peer Advocates (SHIPs) service in Leeds and Bradford in collaboration with Groundswell and 100% Digital Leeds. The project recruited and trained volunteers who had experience as a refugee and/or had faced homelessness to act as peer advocates for digitally-excluded patients in similar circumstances. The programme aimed to benefit patients directly and to support the NHS by easing pressure on services.

Volunteers received comprehensive training to advocate on behalf of patients and to provide them with tailored support and everyday digital skills. This served as an effective route for increasing take up of digital tools and access routes offered by their practice.

Bevan also worked with local partners to provide patients who experienced digital poverty with reconditioned smartphones and data bundles.

Other information

Bevan Health and Wellbeing: https://bevanhealthcare.org/wellbeing/

Conisbrough Group Practice was one of many practices in England that introduced an online system to enable patients to request appointments, advice and other kinds of help from their surgery, using a form on their website. The practice instructed all reception staff to spend extra time talking to patients on the phone about how to find and use the forms and how the practice would respond. More patients started using the forms as a result and other patients who couldn’t use the forms or who preferred not to, found it easier to get through by telephone.

Implementation tips

• Take the time to go through how to use a digital tool, step-by-step, the first time a patient uses it – to identify any access barriers they may face. Without following this process at the outset, patients may get frustrated and be discouraged from using it in the future.
• Provide proxy access features that enable carers and others to submit information on a patient’s behalf.
• Promote the offer of support to use digital tools through different channels: Conisbrough Group Practice used social media, a local magazine, word of mouth and they often explained the benefits of using the website forms when patients telephoned or visited.
• Read “Creating a Highly Usable and Accessible GP Website for Patients” and apply it to ensure the practice website is user-friendly. For example, Conisbrough Group Practice added a big button at the top of their home page to help patients find their way to the website forms they could use to ask for medical help.

The challenge

The practice recognised that some of their patients would not try using the website forms to request care, unless they first received support.

The approach

All practice reception staff were given “permission” and actively encouraged to spend time helping patients to find out about and use the website forms. The practice particularly focussed on identifying people who may not be “tech savvy” and supporting vulnerable and digitally less confident patients by going through the website forms with patients verbally, rather than sending people a link and expecting them to work it out for themselves.

The practice reorganised parts of their website: for example, a button, linking to the page from where online forms could be completed, was placed at the top of the homepage where it could be seen more easily.

Other information

Conisbrough Group Practice: https://conisbroughgrouppractice.co.uk/

NHS England guidance: Creating a Highly Usable and Accessible GP Website for Patients

The Health Connections Mendip team at Frome Medical Practice designed a tailored service for people who are digitally excluded and who need support accessing GP services. The team was supported by a Digital Coordinator, a community-facing Digital Health Connector and over 70 local residents who signposted local services. The main beneficiaries were those over 70 years old and those on low or no income.

Implementation tips

• Get people involved at the GP practice and local community level, to ensure digital access can be offered in lots of ways.
• Link staff in GP practices and the community.
• Offer patients support at their GP practice where appropriate.
• Create links with more specialist resources in the community who can provide ongoing support to the most vulnerable patients.
• Support members of the public so they can help signpost patients to get help with using digital tools to contact their practice or access care or advice. A community-based digital connector or champion is ideally placed to provide training to local residents, increasing the project’s reach.

The challenge

The practice recognised that some of their patients were digitally excluded and needed tailored support to access GP services.

The approach

The Health Connections Mendip team at Frome Medical Practice designed a tailored service for people who were digitally excluded and who needed support accessing GP services. The team was supported by practice-based colleagues – including a Digital Coordinator, and a community- facing Digital Health Connector.

The practice based Digital Coordinator supported patients with digital healthcare via pre-booked face-to-face appointments, such as using the NHS App to access their medical records or attending virtual group clinics. If a patient required more in-depth support or had problems accessing digital services (for example, if they don’t have data or kit), a referral was made to the community-facing Digital Health Connector, who, in turn, offered direct support or signposted the patient to other local organisations.

The Community Connector worked closely with the local council, YMCA, Jobcentre, local police, parole officers and over 70 local residents who signposted people to support in the community.

The Digital Community Connector also linked in with local and national organisations, such as Good Things Foundation, to obtain digital devices and free mobile data.

The service referred people to community activities, including a regular digital cafe – where they received digital and non-digital health support.

Other information

Health Connections Mendip: https://healthconnectionsmendip.org/

Good Things Foundation: https://www.goodthingsfoundation.org/

Together with the North Lewisham Primary Care Network health inequalities team, South East London CCG piloted digital hubs, delivered by care coordinators recruited from local GP practices, to help reduce digital exclusion and support patients to use digital tools to contact their practice or access services. Four hubs were set up in Primary Care Networks in the area and two more are planned.

Implementation tips

• Directly recruit staff to digital inclusion roles: this project found that repurposing existing roles meant interest in tackling digital inclusion was mixed.
• Be open to trying out different approaches: each practice and population is different – talk to the community and find out what the issues are.
• Partner up with non-digital health initiatives: the hub found that conducting outreach work with non-digital health services helped them capture the interest of patients who might not normally engage with digitally-based initiatives.
• Know your community and get in early: when working with diverse populations, knowing what services are available to support patients is key, as specialist charities will have more in-depth knowledge of working with vulnerable patients and can promote the service to them.
• Where the hub is located may impact on GP practice engagement: hubs set up within practice premises tend to be more visible and therefore “on the radar” of practice staff. When hubs are set up in other settings, it is important to ensure GP practice staff know about them and signpost patients.

The challenge

North Lewisham has long-standing health inequalities and high levels of social deprivation. There are many residents who face digital barriers and whose first language is not English. The North Lewisham Primary Care Network recognised that more vulnerable members of the population were less likely to benefit from the ability to contact the practice or access care using digital tools.

The approach

South East London CCG piloted digital hubs to help patients to learn how to use digital health services. Each hub was based in a local GP practice, was supported by a care coordinator, and used existing facilities, for example a waiting room or a shared area in a health centre.

The pilot aimed to reduce digital exclusion and to help reach out to wider community groups and those impacted by health inequalities. It focussed on supporting patients to use online consultation platforms to request an appointment, ask for advice or other help from their practice. It also supported them to participate in telephone and video consultations if these were required.

The care coordinators worked closely with the council and VSCEs and were supported by volunteers from Healthwatch Lewisham. They developed ways of helping patients who spoke limited English, such as offering step by step advice using Google translate. For more complex tasks, hub teams sometimes signposted patients to specialist community organisations. The approach recognised that online contact would not work for all patients for a variety of reasons and it was made clear that they could still contact the practice by phone or by visiting in person if they wanted to.

“We view this as expanding choice for patients and freeing up time through less busy phone lines for those who don’t.”

Other information

North Lewisham Primary Care Network: https://www.northlewishampcn.nhs.uk/

Digital Health Hubs: An evaluation report for the NHS Widening Digital Participation Programme (WSA Community Consultants 2020)

Reaching People (a VCSE consortium working across Leicester, Leicestershire and Rutland) established the Health+ project to offer volunteer-led support with digital skills at GP practices, in order to increase the use of digital tools to access or receive care from practices. As part of the pilot, the project supported Saffron Health to provide digital support to older patients. Some patients reported that they started to use the digital tools as a result of attending the sessions. The project model is being rolled out across 25 surgeries.

Implementation tips

• Work with GPs to understand how they would like their patients to use the digital tools available for contacting the practice or accessing care: this will increase take-up through ensuring that the volunteer offer is tailored to patient needs, including familiarising with digital tools that are used.
• Ask GP practices to nominate a main contact who can liaise with the project: including to attend meetings and liaise and troubleshoot as necessary.
• Ensure volunteers are suitably skilled: as a minimum this will require training around NHS specific online access tools or their chosen digital tools, safeguarding and online security.
• Build in mechanisms to capture outcomes and impact: this helped the project identify practical learning around how sessions are run, the importance of allowing time for ‘word of mouth’ to maximise participation, and the ability to change the project based on changing needs of the practice and patient population.

The challenge

Health+ knew anecdotally from a Patient Liaison staff member and through recent digital inclusion project experience that older patients were less likely to use digital to access GP services.

The approach

The project team liaised with Saffron Health GP practice staff to establish appropriate terms of engagement, and gain an understanding of the patient demographic of their community and the online tools they wished to support their patients to use.

Two Digital Companions were based at the surgery to help people use digital tools and apps and services on their own devices, through one-to-one sessions, booked via the practice. Digital Companions were fully trained in the NHS App, other GP apps, online security, health literacy, safeguarding, and evaluation.

Patients aged over 50 were invited by text message and through leaflets to attend digital skills sessions at the surgery over an eight week period. Twenty six patients joined one or more sessions. Attendees had a wide range of digital abilities – training was tailored to their needs and included basic digital skills for beginners.

Other information

Reaching People Health+ project: https://www.reachingpeople.co.uk/health-project/

GP practices across Sefton were supported to engage with a Digital Champion Programme, resourced through a local quality contract from South Sefton and Southport and Formby CCGs. Digital champions were required to proactively identify and support patients to use digital channels to access care.

Implementation tips

• Providing remuneration for time helps embed digital inclusion initiatives in GP practices: in this case, practices were able to free up a member of staff to become a digital champion and carry out proactive work to reach out to carers.
• Work with the right staff: This project originally had some GP practice managers as digital champions – but this changed to a focus on administrative staff as they could dedicate more time to it.
• Link GP practices directly with services that work with vulnerable patients: trainers were able to act as a conduit through working with community groups and introducing them to time-limited GP practice staff. This supported direct learning about the digital challenges some patients face and helped practices develop the necessary protocols to target inclusive online access.

The challenge

Sefton is a metropolitan borough in Merseyside. Around 24% of Sefton’s population is aged 65 or over. During the Covid 19 pandemic, local carers organisations reported that carers faced particular challenges accessing health care for people they cared for through digital channels. However, GP practices did not have the time or resources to train and support practice staff to become digital champions or take proactive action to identify those carers who needed their help most.

The approach

Through funding offered by local CCGs/ICSs, 47 GP practices nominated a digital champion to work with digital trainers to identify gaps in their digital knowledge, to attend training sessions (10 annually) and to share learning.

The digital trainers worked closely with the champions to ensure any training offered was relevant to the practice’s needs. All training sessions were recorded and shared via an online channel that all digital champions had access to.

Digital champions were required to proactively contact and identify patients who were also carers to find out what help they needed in order to use digital tools to access healthcare. A training session for digital champions included a talk by a local carers’ organisation and step-by-step instructions explaining how carers could obtain “online proxy access” – to request and receive help online.

The digital champions contacted patients on the carers’ register to make them aware of the new online options available, for example, requesting appointments online and ordering repeat prescriptions online for someone they cared for.

Many of the programme’s trainers had worked in or alongside local general practices over a number of years and had good appreciation of the pressures they faced and the need for training to accommodate a range of needs.

Evaluation is underway.

Other information

Carers UK Digital Resource for Carers: https://www.carersuk.org/for-professionals/digital-resource

Sussex Health and Care ICS launched a pilot to evaluate the impact of using digital ambassadors working across Primary Care Networks to improve patient access to healthcare. Employed by GP practices, the ambassadors provided information to patients about the benefits of a range of digital tools and providing training to use them. They also built links with local organisations to help extend the support available.

Implementation tips

• Harness the advice and experience of Patient Participation Groups in shaping your approach.
• Involve Primary Care Network leaders to encourage GP practices to embrace and promote the digital ambassador role.
• Allow the digital ambassador role to evolve. Identify which digital tools to focus on, reflecting clinical priorities and patient feedback.
• Partner with respected local organisations so patients can learn about digital healthcare tools in a relaxed setting.
• Evaluate impact and share learning across Primary Care Networks.

The challenge

The Sussex Health and Care ICS Digital First programme seeks to support use of digital technology to empower people to manage their health and wellbeing with the additional aim of reducing the burden on administrative and clinical staff in general practice. Four of the nine Primary Care Networks that took part in the pilot were in the 20% most deprived areas in England.

The approach

Sussex Health and Care is evaluating the impact of the pilot on patients’ digital access to healthcare. The pilot operated at Primary Care Network level and involved a range of digital tools, including the NHS App, online consultation, NHS 111, GP surgery websites, the Patient Access System, My Health and Care Record (link to hospital appointments and diagnostic test results); and health monitoring tools (for example, blood pressure and long Covid monitoring).

The pilot included between 12 and 16 ambassadors, each directly employed by GP practices, and who typically worked for one day a week. They trialled different ways of working and a range of patient groups. For example, one Primary Care Network collaborated with a community organisation to promote and deliver a digital drop-in support service for a population of vulnerable, older people living in an area of deprivation. Ambassadors also visited voluntary and community groups to support people outside GP surgery settings. They shared best practice via MS Teams.

The pilot benefitted from a sister project on Digital Skills Inclusion. This had developed a series of accessible, user-friendly guides co-designed with voluntary and public sector partners. The resources helped guide people through a range of tools, such as the NHS App. The pilot also benefitted from e-learning modules created by Digital Facilitation and People teams at Sussex Health and Care ICS. Funding from NHS England enabled ambassadors to access training through the Digital Champions Network.

Both projects had support and advice from Patient Participation Groups.

Initial pilot feedback from both patients and GP practices has been positive. Evaluation will be completed in 2023.

Other information

Sussex Health and Care: https://www.sussex.ics.nhs.uk/

Sussex Health and Care guides: https://www.sussex.ics.nhs.uk/our-vision/priorities-and-programmes/digital/digital-healthcare-tools/nhs-app-support-resources-for-volunteers/

Digital Unite: Digital Champions Network

The Project Surgery, which serves a deprived multi-ethnic community in Newham East London, offered telephone and face-to-face training and support to vulnerable patients during Covid-19 to help them use an online consultation system. Staff overall reported an improved work-life balance and administrative staff spent less time answering phones and face-to-face enquiries as a result of increased usage of online consultation requests. Patients who spoke limited English said they preferred using online forms to the telephone to request an appointment, advice or other help as it enabled them to provide information at their own pace.

Implementation tips

• Build in time to provide “in the moment” training: this requires a sufficient number of admin staff to identify patients who telephone or visit to offer training there and then, giving regard to the fact that vulnerable patients, or those who speak limited English, need more time.
• Provide a private space: as patients may discuss sensitive information when being shown how to use an online form, access to a private room in the practice should ideally be available.
• Build in flexibility: this is key when working with patients who experience day to day struggles. Allow patients to complete an online form at a time that suits them, ask relatives to support them if they wish.
• Where possible, ensure all aspects of digital need are supported: provide access to data and devices in the practice for those who experience digital poverty, alongside staff who have the time to go through how to use these (for those who lack skills or confidence).

The challenge

When the practice went online in March 2020 due to the Covid-19 lockdown patients were encouraged to use an online consultation form. There was a concern that some patients would struggle due to low literacy levels, limited English language skills, and lack of access to a device. Located in North East London, the project serves one of the most ethnically diverse populations in London living in an economically deprived area. Over 200 languages are spoken. The area had one of the highest Covid-19 death rates in the third wave.

The approach

Administrative staff were given permission by the practice manager to take more time to offer training and support to all patients who contacted the practice by telephone (and those who visited face-to-face once lockdown restrictions ended). Many of the patients supported spoke English as a second language.

To combat those unable to access digital services due to affordability (tools or data) the practice purchased an iPad with WIFI for patients to use and a mobile phone with credit on it.

“We let them have an iPad and sit with them. There is a private area in the practice that is quieter outside of the waiting room. We take them into the room to train them – a little space where patients can take their time.”

Whilst the practice used Language Line interpreters for telephone assessments, this sometimes felt rushed even if a double appointment was booked. Supporting patients to use an online form meant they could take their time completing information.

The practice operated a remote consultation system alongside traditional methods for 10 years, so staff were able to build on training already received. The practice also experienced lower demand during the first lockdown, meaning reception staff were able to put time into training patients.

Other information

The Project Surgery: https://www.theprojectsurgery.com/

Thistlemoor Medical Centre was involved in a pilot which aimed to increase patient engagement with the online NHS Diabetes Prevention Programme (NDPP). The practice developed tailored patient communication and offered telephone and face to face support. The approach led to an increase in referrals in the month post-intervention and the practice moved from the bottom to the top quartile in the country in three treatment targets (HbA1c, blood pressure and cholesterol).

Implementation tips

• Having a staff member who is persistent at contacting patients is key: there is a need to keep trying with patients who struggle to prioritise their health due to financial difficulties or other life pressures they may face.
• It is worth taking extra time to ensure communication is bespoke: the practice included information specific to the patient when sending out texts.
• Don’t be afraid to try things out to see what works: Thistlemoor Medical Centre developed a set of simple questions to ask patients verbally, when a digital questionnaire was found to be less effective for patients who struggle with English.
• Employ and develop a team of healthcare assistants who can take more time to offer targeted support to patients, including how to access services or contact their general practice using digital tools.

The challenge

Thistlemoor Medical Centre was struggling with diabetes performance and was in the bottom quartile nationally for eight care processes and treatment targets. Located in an economically deprived part of Peterborough, the majority of the local population had limited English language skills.

The approach

The NHS Diabetes Prevention Programme (NDPP) is an evidence-based intervention which aims to reduce the risk of people developing Type 2 Diabetes Mellitus (T2DM). It is available in a number of languages. The practice was involved in a pilot to identify whether sending text messages to patients living with pre-diabetes would encourage engagement. SystmOne and EMIS reports were created to identify all eligible patients. Each text was bespoke to the individual and included their blood sugar level or HbA1c result and NHS patient number.

The practice was supported by a number of healthcare assistants (most recruited through the local community) who had the time to talk to patients and offered more support if needed. The assistants were multi-lingual and, where possible, communicated in the patient’s own language.

Whilst the pilot has now ended, healthcare assistants continue to support patients with the use of digital tools where needed.

Other information

Thistlemoor Medical Centre: https://www.thistlemoor.co.uk/

Vista, a charity, supports nearly 6,000 people living with sensory loss, including dementia and learning disabilities in Leicester, Leicestershire and Rutland. It provided tailored support to enable clients to use digital tools to contact their general practice, and access care and advice. Clients provided positive feedback about the support they had received.

Implementation tips

• Accessibility has to be factored in at registration: GP practices should capture information about the ways patients prefer to contact the practice and be contacted and these should be highlighted in each patient’s health record.
• Partnering with a specialist VSCE organisation with in-depth knowledge of how sensory loss impacts accessibility can be very effective.
• Invite patients who have identified accessibility issues to a focus group: this can help ensure patients have a say in how online access should be supported.

The challenge

Vista recognised the urgent need to provide support for their clients who were living with sensory loss during the Covid-19 pandemic.

The approach

Vista’s Digital Dynamos Service, funded through the National Lottery, offered an initial assessment of their clients’ needs and provided one-to-one support to help them learn to access services using digital devices. Some additional funding was provided by the local CCG to help clients to use the NHS App.

As a specialist charity, Vista brought accessibility issues to the fore when working with its clients, including access to GP services using digital tools. They also provided detailed knowledge of national guidance and policy, such as NHS Design Standards, and of what is needed to ensure GP websites are accessible – something busy GP surgeries can struggle with.

Other information

NHS England guidance: Creating a Highly Usable and Accessible GP Website for Patients

Vista: https://www.vistablind.org.uk/