If you’re a GP you will by now be familiar with the NHS England requirement for “25% of appointments to be bookable online”. If you’re a commissioner you may be fretting about how to measure it. Anyone else is most likely bemused by another arbitrary number of little relevance.
But there’s a dark side to arbitrary requirements, and with this one it is faced by the digitally disadvantaged. We instinctively know that those least capable of booking online, for reasons of age, deprivation, mental capacity or simply being ill, are disproportionalely most in need of help from their GP.
The good Dr Julian Tudor-Hart called it the “Inverse Care Law” and it can only be overcome by deliberate policy. By carving out GP capacity for a relatively advantaged group, this policy stokes and promotes that law. Shame.
You may look to BMA guidance on how to dance around the policy: in essence, 25% can be for any clinician, at any time, so it could be all the HCA appointments bookable 4 weeks hence. That ensures the box is ticked, but do we really want to manage compliance by frustrating policy?
Regular readers would expect me to offer a radical and practical alternative, and I’ll try not to disappoint.
We believe that 100% of patients should be able to get help online. And we believe that 100% of patients should be able to get help by telephone. Same goes for walk-ins.
How so? It’s all the same capacity, none is reserved for any group or mode of contact. The point is that a patient can’t reserve any GP capacity, it’s up to the GP to decide what is the best way to help. Patients can request help by any mode, but all requests go into the same flow at the same time, managed by the GP according to need: none has an advantage.
We are concerned to make life easier for both patients and GPs, and we know that online requests are much faster for GPs to deal with so we encourage patients to go online. It turns out that the 25% figure is unambitious. The lowest rate of online requests for any of our total flow practices is 35%, and the average 56%. I visited one in a perfectly ordinary part of Wigan last Wednesday which gets 75% online. That’s Wigan, not Westminster.
Median time to complete a requests at the practice, Shakespeare Surgery, is 31 minutes (if they need to be seen it will be later the same day).
– patients will do what works for them, not what they are told
– online requests can work for all ages and conditions (though usage is lower with greater age)
– online is more efficient for GPs and receptionists, freeing up time for those who still need to use the telephone.
In order to deliver the outcomes we all want, system change not arbitrary targets are needed, and suddenly it makes sense to abolish the existing assumptions and methods.
We’ve added a criterion by which we judge progress with askmyGP:
The service must benefit non-users.