Primary Care Pathfinder – discovery report
- Executive summary
- What we focused on
- What we did
- What we found out
- The health and care system faces multiple challenges
- These challenges are forcing changes to models of health and care
- Some alignment with the future model is evident across primary care
- Expanding records access for citizens offers both challenges and benefits
- Information sharing between professionals is a key challenge for the future model
- Access to GP services remains the main challenge for citizens
- Managing demand is the main challenge for practices
- Practices are changing how citizens access services
- Citizens’ preferences for accessing services depend on the context
- Different access models may lead to inequities
- Digital tools have not been consistently successful for clear reasons
- Opportunities for further work
- Next steps
Digital Services for Patients and Public (DSPP) asked the Centre for Digital Public Services (CDPS) to run a 12-week discovery project.
The project’s aim was to carry out research to understand what DSPP should consider when developing public-facing digital services to improve primary care so that they:
- support user needs and accessibility
- support national policies and strategies
- have the flexibility to adapt to future developments in models of care
Note: by ‘primary care,’ we mean services that provide the first point of contact in the healthcare system, acting as the ‘front door’ of the NHS. Primary care includes general practice as well as community pharmacy, dental, and optometry (eye health) services.
This is a summary of the full report provided to DSPP. It has been edited to make it more concise and to remove any information that could identify those that participated in the research.
2. Executive summary
CDPS carried out 12 weeks of research into what the DSPP programme should consider when developing public-facing digital services aimed at improving primary care delivery. This work was commissioned for two reasons.
First, the pandemic caused a period of turbulence during which multiple public-facing digital products were deployed rapidly in primary care. These products aimed to support infection control and keep services running. Little was known about the experiences of using these new tools for citizens or GP surgeries.
Second, DSPP is developing the NHS Wales app. It wanted development to be informed by a broader understanding of the primary care landscape.
Focus on citizens and surgeries
The research focused on citizens and GP surgeries. While primary care also includes pharmacy, optometry and dentistry – and is supported by other healthcare professionals in the community – the highest volumes of demand are seen in general practice.
The research team interviewed citizens and GP surgery staff with a range of characteristics. We learned about their experiences and challenges. We also reviewed other relevant studies, including quantitative ones with large sample sizes.
The team interviewed a selection of primary care stakeholders in parallel. Many are working on primary care in policy, strategy, management, scrutiny or commercial-sector roles. The remainder are healthcare professionals representing the roles of the other primary care, community and allied health professionals. We learned about their work and perspectives on the problem space.
Rising demand changing primary care model
It is clear primary care faces many challenges, but demand that is outstripping capacity is the core problem. These challenges are forcing the primary care model to change. There are efforts to both reduce demand and rebalance it across a wider range of services. Early evidence of these changes is apparent in all areas.
Information sharing through digital channels has a critical role to play. Allowing citizens to easily access their own GP health records online has both benefits and disadvantages. However, that access is expected to support a more proactive role in people’s own health and care, while reducing demand on practices. Also, more seamless sharing of information in the GP record between professionals caring for a citizen is needed. It will be fundamental to redistributing demand across organisational boundaries.
Primary care is dominated by two interlinked issues: access to GP services for citizens and demand management for practices. Digital interventions have been widely used in other sectors to mitigate challenges like this. They have not been consistently successful in primary care in Wales. We found several reasons for this outcome. Some of them were caused by the pandemic. But broadly speaking, digital tools have been too often procured and deployed without sufficient understanding and consideration of:
- the detailed needs of the citizens or practices who will use and run them
- how they will work together with the rest of the public-facing service that practices offer to citizens
This has led to confusion and frustration for some citizens and a perceived increase in demand for some practices. Practices have reacted by turning off or otherwise limiting access to various types of digital functionality. Wide variations in how GP services can be accessed have emerged. We found that a choice of access methods better supports the variety of tasks and contexts citizens present with; this may be severely limited in some areas.
Digital tools should remain an important part of strategies to mitigate access and demand challenges in primary care. We should learn from the experiments carried out during the pandemic. Many people we spoke to across all strands of research feel now is the time to intensify efforts to use digital services more effectively in primary care.
We recommend several high-value opportunities for more focused work, including:
- better understanding the nature of demand in GP surgeries – this is essential to demand mitigation
- testing what outcomes can be achieved by enabling and promoting online access to citizens’ summary health records – a clear understanding of the benefits and disadvantages could support a wider rollout
- improving consistency in how GP services are accessed – this is important to minimise potential inequities
- testing what outcomes can be achieved with a set of multichannel access methods that have been designed and tested to work together, around the needs of citizens and practices – this could both improve access for citizens and reduce demand on practices