Digital transformation has been a long-term strategic goal for the NHS, even before the outbreak of COVID19. The pandemic, however, accelerated the shift to online and telephone appointments to help manage infection risks whilst still caring for millions of people.
Whilst the changes worked for many, the reduction in in-person consultations has left others struggling to access the care they need. Among those affected were often the most vulnerable in our society: older people, disabled people, people on low incomes, and those whose first language isn't English.
NHS England has recently issued new guidance to GP practices to facilitate face-to-face appointments for patients. The move also looks to retain some of the advantages of remote care as the sector looks to find the right balance for the future.
Undoubtedly, digital and remote methods will play an increasingly important role in how people access care going forwards. To ensure that no one is left behind, we need to do everything possible to reduce barriers to accessing care remotely while giving people the agency to decide what kind of appointment is right for them.
About the report
Our analysis investigates the barriers to accessing digital and remote care, drawing on the experiences of people who experienced digital exclusion during the pandemic.
- 86 patients and 26 members of primary care staff.
- 34 older people aged between 60-89 years old.
- 31 disabled people.
- 21 people who experienced language barriers.
- More than a quarter of the people we spoke to were from a minority ethnic background.
What we found
The reasons why participants felt digitally excluded are described below in order of how frequently they were reported. These include:
- Lack of interest in using technology and going online
“I don’t want to use computers and I don’t feel I should have to be forced to do this...I think you should have a relationship with your doctor – I prefer to see the same doctor as I like that personal touch.”
- Lack of digital skills
"I tried to ring the surgery only to ask about this letter that I have had from Matt Hancock [the Government] about needing to have vitamin D supplements as I am a shielding patient. I rang the surgery because this letter told me to go to www…… and click? Well, I have no idea about computers – it is like talking in a foreign language."
- Age and disability
"For repeat prescriptions you use an online app which I struggle with because I can only use one hand as my left arm is disabled and my shoulders are weak."
- Lack of trust
"I have no one to ask to help me with this. I am a little bit worried about fraud and less interested in learning about this as I am getting older."
- Language barriers
"I know they do telephone consultations, but it is not suitable for people like me. My English is weak, and I am not sure I would be able to explain myself on the phone."
- Affordability of technology
"I would use a computer and like to be able to get access to the internet if it was affordable. I would rather I could communicate with my GP online; it would be easy and convenient."
As for staff, whilst most expressed broadly positive views about the shift to remote care, they also acknowledged that the pace of the changes had been swift. All staff interviewed emphasised the importance of seeing people face-to-face, with several pointing to hybrid model striking the right balance.
Our recommendations for post-COVID-19 digital healthcare
The report points to the need for a bold programme of investment in digital literacy and online access while emphasising the importance of maintaining face-to-face methods to ensure no one falls through the gaps.
- Maintain traditional models of care alongside remote methods and support patients to choose the most appropriate appointment type to meet their needs
Practices should respect patient's preferences for face-to-face care unless there are good reasons to the contrary. Giving people the agency to say what is right for them is not about giving people what they 'want' but a vital way for the system to manage people's varying needs more effectively.
As we move out of the pandemic, the NHS must support the effective and safe use of remote consultations and different triage models while offering a mix of remote and in-person appointments. This would be based on shared decision-making between GPs and patients.
- Invest in support programmes to give as many people as possible the skills to access remote care
While not everyone will have the capacity or desire to access remote or digital care, we know that the proper training and support can help people who were previously digitally excluded from getting online.
The NHS must commit to improving digital literacy as part of its post-pandemic recovery strategy.
- Clarify patients' rights regarding remote care, ensuring people with support or access needs are not disadvantaged when accessing care remotely
NHS England should develop a code of practice clarifying patients' rights to receive services online or offline, alongside the kind of support they are entitled to both on and offline, like access to an interpreter. Ultimately, this should become a core part of the NHS Constitution.
More broadly, NHS England should produce a single vision statement setting out national expectations for the role remote care plays in transitioning out of the pandemic.
4. Enable practices to be proactive about inclusion by recording people's support needs
The healthcare system must understand people's individual support needs. This will be essential in removing all barriers to accessing services.
In our research, both patients and staff suggested that practices should code patient records with information regarding a patient's language, communication needs and level of digital skills. Staff can then be proactive about offering people an appropriate consultation type or pre-empt requests for adjustments in future.
5. Commit to digital inclusion by treating the internet as a universal right
In its report 'Beyond Digital', the House of Lords Covid-19 Committee recommends that the Government consider introducing a legal right to internet access, giving people a ringfenced benefits entitlement to access affordable internet.
Indeed, the national ambition to provide digital-first primary care to everyone should be underpinned by a universal right to internet access, ensuring the NHS remains genuinely free at the point of use.