13 April 2026
This paper can be downloaded as a pdf file here.
This paper is based on the belief that GPs and their practices should do what they can to ensure that in the NHS’s current shift from analogue to digital,[1] patients who are ‘digitally excluded’ because they aren’t internet savvy or don’t have a reliable internet connection do not miss out on information about the practice and the services that it provides. It argues that surgeries should respond to their needs by publishing a ‘practice information booklet’ for patients. Indeed, such a booklet can convey information that is not on the website but would be useful to patients who are online too. And it would be perfectly feasible to render such a booklet, unlike a website, as an ‘easy read’ document for patients with a learning disability.[2][3]
The national picture
A study carried out in 2024 for Age UK found that of the UK population aged 65 and over, 2.4 million people (19% of the age group, so by no means an invisible minority) used the internet less than once a month or not at all.[4] Whatever the reasons for this low usage, those 2.4 million older people are ‘digitally excluded’ from society. So too, of course, are a proportion of the 1.2 million or so adults in the UK who have a learning disability[5] and an unknown number of families who cannot afford the equipment they need to get online.
Case study: digital exclusion in Penwith
The Penwith peninsula, the south-west tip of Cornwall, includes the towns of Penzance and St Ives, as well as a large rural area with many villages. More than 67,000 registered patients live there. Primary health care is provided by seven GP practices, which together constitute the Penwith Primary Care Network (‘the PCN’).
The PCN’s website[6] tells us that its population ‘includes people in the highest levels of deprivation’ in Cornwall. Indeed three of Penwith’s neighbourhoods are among the seventeen with the highest levels of multiple deprivation in the whole of Cornwall.[7] (All three are in urban areas, which suggests that in assessing deprivation insufficient weight has been given to the hardship existing in Penwith’s rural areas, where the provision of GP and other services is visibly patchy.[8]) It follows that people who are digitally excluded comprise a significant proportion of Penwith’s patient population.
Digital exclusion in Penwith: the local reality
Ms Pip Macmeikan, who is employed by Volunteer Cornwall as a Community Maker, works closely with community hubs in Penwith. Her work brings her into contact with a wide variety of people in rural areas. She has a number of pertinent observations:[9]
1. Even if people have a mobile phone, they don’t always have a reliable signal – 3/4/5g or Wi-Fi. In many rural areas, the signal is patchy at best.
2. Many people can’t afford sufficient data for everything that needs doing online.
3. Many older adults lack confidence in using technology. ‘When they are shown the basics they remember them, but if there’s an update, or they need to log in again or something changes, it can completely throw them. When the technology doesn’t work, it causes some people considerable anxiety.’
4. While mobile phones and tablets are invaluable, people looking for information can often find it more easily on a laptop or desk computer. Ms Macmeikan has been using a laptop in community centres when helping people to fill in forms to claim benefits because those forms don’t load properly on their mobile phones.
Producing practice information booklets: a role for the Primary Care Network
Evidently it cannot be taken for granted that everyone who lives in Penwith has straightforward access to the internet. But there is an obvious remedy to digital exclusion that is available to practices: produce a booklet for patients that contains information that patients will find useful – about the practice and about how to recognize emergencies – and that omits the encyclopaedic and often badly written stuff that NHS England currently requires practices to include on their websites.[10]
Producing a high-quality practice information booklet for patients could well stretch the resources of a single practice, but it is something that the Penwith PCN could and should certainly assist with, given that (as its website tells us[6]) its role is to ‘assess the needs of the local population and to work with local community services to make support available to people where it is most needed’. Moreover, the PCN has funding to recruit staff ‘to provide additional roles to create bespoke multi-disciplinary teams within its individual network’.
So, although the needs of digitally excluded patients are not specifically mentioned on the PCN’s website, using part of its funding to set up and host a team to lead the design and publication of practice information booklets would certainly meet its brief. The team would need to include people who have relevant experience and possess the understanding and empathy needed to work co-operatively with patients who are digitally excluded.
This co-operative model of working is akin to ‘co-production’, which NHS England actually advocates as ‘a way of working that involves people who use health and care services, carers and communities in equal partnership; and which engages groups of people at the earliest stages of service design, development and evaluation’.[11] While that definition unfortunately fails to incorporate any undertaking to involve patients in actually taking decisions, it does at least acknowledge a role for patients.
It remains to be seen whether the Penwith PCN as currently constituted can accommodate itself to this way of working. Sadly, it has so far not established a good track record for involving patients in website design. When new websites for the Penwith GP practices were launched in 2024, it was suggested that the Patient Participation Groups of the seven practices be invited to ‘road test’ them, but this suggestion fell on deaf ears.[12]
There are useful lessons to be learned from practice information booklets that already exist elsewhere
A particularly useful example is the 12-page booklet produced by the Brookside Group Practice, located in Wokingham, Berkshire. This multi-surgery group practice is a PCN in its own right. Its booklet can be downloaded from its website as a pdf.[13]
Among other things, this practice uses its booklet to convey some potentially life-saving information that NHS England does not see fit to include in pages that it requires GP practices to place on their websites. At the top of page 2, the booklet tells the reader:
For immediate, life threatening emergencies, call 999. Chest pains and/or shortness of breath constitute an emergency.
While one might wish to add the symptoms of stroke as indicators of an emergency, at present NHS England currently takes space on GP practices’ websites to tell patients what to do ‘if it’s an emergency’, or ‘if it’s a serious or life-threatening emergency,’ but nowhere does it tell patients how to recognize an emergency when they are confronted with one! The Brookside booklet does give us a model that a practice information booklet for Penwith practices could usefully follow.
Notes and references
All web sources last viewed on 3 April 2026
1. UK Government, Fit For The Future, 10 Year Health Plan for England, CP 1350, July 2025
https://www.gov.uk/government/publications/10-year-health-plan-for-england-fit-for-the-future
2. MENCAP, What is an easy read? 2024
https://www.mencap.org.uk/easyread/what-easy-read
3. Photosymbols, Making information easier to understand, undated
https://www.photosymbols.com/
4 Age UK, Age UK warns 2.4 million digitally excluded older people are at risk of being left behind in an increasingly digital world, 29 July, 2025
https://www.ageuk.org.uk/latest-press/articles/age-uk-warns-22.4-million-digitally-excluded-older-people-are-at-risk-of-being-left-behind-in-an-increasingly-digital-world/
5. MENCAP, Health – research and statistics, undated
https://www.mencap.org.uk/learning-disability-explained/research-and-statistics/health-research-and-statistics
6. Penwith Primary Care Network, About Us, Welcome to Penwith PCN!, 2026
https://www.penwithpcn.nhs.uk/about-us/
7. Retrieved from T Ovenden-Hope, V Brown & E Achtaridou, The Pretty Poverty Report: Cornwall Rurality Matters, 2025, p.17
https://cornwallreports.co.uk/wp-content/uploads/2025/09/The-Pretty-Poverty-Report.pdf
8. Ibid.
9. Ms Pip Macmeikan, Information made available to Penwith Integrated Care Forum, 2025
10. Peter Levin, GP surgeries’ websites are useless if you need help in a hurry – thanks to NHS England!, 9 April 2026
https://spr4cornwall.net/surgeries-websites-are-useless-if-you-need-help-in-a-hurry-thanks-to-nhs-england/
11. NHS England, Co-production, undated
https://www.england.nhs.uk/always-events/co-production
12. Peter Levin, GPs say they want to hear patients’ views, but they aren’t inviting patient
participation groups to ‘road test’ their surgeries’ new websites, 27 August 2024
https://spr4cornwall.net/gps-say-they-want-to-hear-patients-views-but-they-arent-inviting-patient-participation-groups-to-road-test-their-surgeries-new-websites/
13. Brookside Group Practice, Leaflet full version, October 2025
https://brooksidegrouppractice.co.uk/wp-content/uploads/2025/10/BGP-leaflet-full-version-October-2025.pdf