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

This report can be downloaded as a pdf file here.

IN A NUTSHELL

GPs have long portrayed themselves as constituting the ‘front-line’ of the NHS in England.[1] Today, with every surgery now having its own website, NHS England tells us that GP websites are now the front door to NHS care for many patients.[2] But look behind that front door and what you see is not good news for patients.

In areas as different as Penwith, in the far West of Cornwall, and Bolton, in Greater Manchester, surgeries in Primary Care Networks (PCNs) have gone live with a model website that is being widely marketed by Agilio Software.[3] The web-sites are a mixture of Agilio-designed pages, pages supplied by NHS England, and text supplied by the surgeries and PCNs themselves. In neither area have the surgeries invited their patient participation groups (PPGs) to ‘road-test’ the new websites before they go live to see how straightforward they are to use.

This study of the new websites has found pages that

(1) offer advice that can waste a patient’s time when seeking urgent treatment;

(2) fail to explain that there is no longer any such person as ‘your GP’;

(3) insist that it is the receptionist who takes your phone call who will choose which
member of staff you should see;

(4) suggest that some surgeries have no interest in learning from others;

(5) suggest there is resistance in surgeries to patient participation groups taking an
interest in matters of surgery management and policy-making.

1. Do you need treatment urgently? Advice has been given on a surgery website that could waste crucial time when seeking urgent treatment. You might be in Penzance (in Penwith), with a member of your family who has become unwell and needs medical attention urgently. On one local surgery’s Agilio-designed Home page you discover a link called ‘Find urgent treatment centres’. That link takes you to an NHS-designed page headed ‘Find urgent and emergency care services’. Scroll down and you find another link: ’When to visit an urgent treatment centre (UTC).’ But nowhere on this web page headed ‘Find urgent treatment centres’ are you told that you can actually find a UTC less than half a mile down the road from the surgery, where you will usually be seen without an appointment.

2. Who is my GP? Perhaps, especially if you have been a patient of the NHS for many years, you want to know who ‘your’ GP is. You may have come across the current Royal College of General Practitioners’ guide for patients that says: ‘A GP is your family doctor and is the main point of contact for general healthcare for NHS Patients.’[4] But surgeries’ new websites won’t give you that message.

In Bolton the websites all tell you the surgery accepts that all patients registered must by law be allocated ‘a named accountable GP’ who is responsible for co-ordinating services, but will not be the only GP or clinician who will provide care to that patient. If you ask you will be given that GP’s name, but all the Bolton surgeries say they won’t write to patients to volunteer that information.

In Penwith none of the three Agilio-designed websites that have gone live even mentions the existence of named accountable GPs. This rather suggests an attitude towards patients of ‘how the surgery works is not your business’.

3. Phoning to book an appointment. If you want to phone the surgery to make an appointment to see a doctor, the Agilio-designed website tells you that you’ll be speaking to a receptionist: ‘We’ll ask what you need help with. We will use the information you give us to choose the most suitable doctor, nurse or health professional to help you.’ What you will not know is what training the receptionist has received to equip them to do that choosing. Does it amount to ‘sitting by Nellie’ and learning by imitating, which can lead to training being incomplete and ‘red flag’ calls being missed? Does it amount to learning how to be a ’guard dog’, trained to protect doctors from patients’ demands? And what receptionists (and websites) won’t tell you is that there is usually a duty doctor available to whom you can appeal if you feel the receptionist isn’t taking your issue as seriously as it deserves.

4. Do surgeries learn from one another? Their websites sometimes suggest that staff pay little attention to what other surgeries are doing and consequently fail to learn from them. There are always ‘good practice’ tips to be picked up. For example, the website of Bodriggy Surgery in Hayle (Penwith) shows that instead of receptionists it has patient advisors, an altogether less intimidating role and title, which has just been adopted by Marazion Surgery. Again, the website of Rosmellyn Surgery in Penzance has mini-biographies of its doctors on its ‘Meet the team’ web page: these convey not only that the doctors have specialist clinical interests but also that they are real human beings, not the impression one gets from seeing just a set of abbreviations after their names. Website designers can add value to their products by spreading the habit of learning, noting innovations that their clients have made and suggesting them to others.

5. Patient participation groups. Since 2015, the GP contract has required all surgeries to develop a ‘patient participation group’ (PPG), and all the Agilio-designed websites have a section on it, evidently supplied by the surgeries themselves or their PCN. All of them feature an invitation to patients to ‘have your say’ on aspects of their experiences, and to do so by responding to surveys of patient satisfaction. This mode of interaction gives the surgery control over the subject matter covered and the questions that are asked. There is no dialogue.

Similarly, the three Penwith websites invite patients on every page to ‘Help us to improve our website content’ and ask ‘How helpful did you find this page?’, then merely invite them to select one of four emojis with different facial expressions!

Very different are ideas put forward in Patient Participation Groups, the guide to setting up and developing a PPG published by the Patients Association in 2021 and endorsed by NHS England. PPG members can ‘give patients and practice staff the opportunity to meet and discuss topics of mutual interest; provide a means for patients to become more involved and make suggestions about the services they receive; and explore issues from patient complaints and patient surveys’.[5]

These suggestions add up to a much more active role for PPGs than surgeries seem prepared to envisage. Perhaps this indicates that clinicians, practice managers and software designers are discomfited by patients who ask questions.

On a personal note, having been assured by Penwith PCN’s IT Manager / Digital & Transformation Lead that I would be able to see the websites before they went live, I was disappointed that this did not happen and that I could not submit my comments before they were launched. He is sure that PPG feedback will be well received by the developers, and that he anticipates that ‘the patients of Penwith PCN will have an NHS website experience second to none’. I am hopeful too.

Sources

[1] C. Simon et al, Oxford Handbook of General Practice, 5th edition (2020), p.4,
OUP, Oxford

[2] NHS England, Creating a highly usable and accessible GP website for patients,
2 August 2023
https://www.england.nhs.uk/long-read/creating-a-highly-usable-and-accessible-gp-website-for-patients/

[3] Agilio Software, https://agiliosoftware.com/

[4] Royal College of General Practitioners, It’s Your Practice: a patient guide to GP services, July 2011
https://assets.nhs.uk/prod/documents/rcgp_iyp_full_booklet_web_version.pdf

[5] The Patients Association, Patient Participation Groups: A guide to setting up and developing your PPG, April 2021
https://www.patients-association.org.uk/Handlers/Download.ashx?IDMF=3a099b36-93af-4582-a267-d4806ddbb1f8

Websites visited (last viewed 27 August 2024)

Penwith

Atlantic Medical Group: https://atlanticmedicalgroup.co.uk

Bodriggy Health Centre: https://bodriggysurgery.co.uk

Marazion Surgery: https://marazionsurgery.com

Morrab Surgery: https://morrabsurgery.co.uk

Rosmellyn Surgery: https://rosmellynsurgery.co.uk

Stennack Surgery: https://thestennacksurgery.co.uk

Sunnyside Surgery: https://sunnysidesurgerypenzance.co.uk

Bolton

Chorley Roads PCN: https://www.chorleyroadpcn.nhs.uk/