Down the line: Patient stories of digital primary care in a pandemic, and building better access for all

Written by Julia Holding and Madeleine Maxwell

There have been gradual changes to the ways in which primary care has been delivered in the last five years, with some online and video and phone consultations being introduced.  During the 2020/21 Covid-19 pandemic, the pace of these changes has significantly accelerated in order to minimise direct contact between staff and patients.

Traverse was commissioned by the Transformation Team – Public Health and Primary Care, NHS England and Improvement, East of England in early 2021 to explore patient and carer experiences of remote digital care in the East of England during the Covid-19 pandemic.

This work sought to hear about primary care experiences in patients’ and carers’ own words. The focus was not only on the practical aspects of seeking and receiving care but on understanding how these changes were felt within the context of the pandemic. The work was designed to seek the views from a diverse group of people to understand how people’s backgrounds, context and specific needs or barriers might have impacted their experiences.

You can read a summary of the themes from these conversations with some recommendations for those involved in designing future digital primary care services in our report here. These themes and stories also informed the development of an animated film to support training for primary care staff and others.

This work was developed in close collaboration with a multi-disciplinary team consisting of GPs, digital specialists; as well as patient engagement, transformation, commissioning and communications managers, referred to in this report as the patient voice steering group.

Overall, these conversations painted a varied and nuanced picture of primary care over the last few months. Whilst the changes have brought about some real benefits and positive impact for some people, they have also introduced or compounded barriers to accessing information and care for others. These conversations also helped to challenge some assumptions and stereotypes around who can benefit or struggle as a result of shifts to digital care delivery. These themes and others are explored in more detail in the report. Two key themes are highlighted below:

• Being “digitally savvy” is not the only thing that people need to feel confident and comfortable using online forms to contact their GP – it’s also about the kind of questions they have, the nature of their relationship with their doctor and surgery, and how easy it is to use specific systems. For example, we spoke to several young people who use digital technology for work, in their studies, and to stay in touch with friends and family, but said they would still much prefer to talk to a GP on the phone or in person if given the choice.
• The shift to remote care delivery has reduced the visibility of services, and introduced some new barriers to booking appointments and requesting information or support – this includes long queues on the phone, and increasing dependence on children and carers for those without the skills, confidence or devices to access services online.

“There is no one-size-fits-all. It takes away people’s independence if they have to rely on a friend or family member... and some people don't have those support networks.”

Through this research, four opportunity spaces for increasing the accessibility and inclusivity of digital and remote primary care delivery emerged. Prompts and considerations around each of these opportunities are explored in more detail in the report.

1. How can we ensure patients and carers have choice over the ways in which they can engage with their GP surgery?
2. How can we support practice staff to continue to deliver high quality care over phone and video consultations?
3. How can we involve patients and carers in the design of new systems, processes and services?
4. How can we embed access and inclusion into the design of our communication, systems and services?

“It would be great if before a practice website goes live it is accessible, for example all content can be used in ‘read aloud’ software. There are visually impaired people who would be willing to work with practices to help this to happen.”

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