The impact of eHealth on relationships and trust in primary care

Ramachandran, M. et al. | The impact of eHealth on relationships and trust in primary care: a review of reviews | BMC Primary. Care 24, 228 | https://doi.org/10.1186/s12875-023-02176-5

Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships.

A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analysed. A total of 79 reviews were included.

Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organisational factors, such as patient sociodemographics, provider communication skills, technology design, and organisational technology implementation, respectively.

Recommendations are provided for effective and equitable technology selection, application, and training to optimise the impact of eHealth on relationships and trust. The review findings can inform providers’ and policymakers’ decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.

Full paper: The impact of eHealth on relationships and trust in primary care: a review of reviews

Delivery plan for recovering access to primary care

NHS England

This document sets out NHS England’s plan to improve access to primary care, better support patients to manage their own health, and to modernise general practice for future generations.

Also published alongside the delivery plan, is the NHS England-commissioned Academy of Medical Royal Colleges (AoMRC) report into improving the primary – secondary care interface. Their report – General Practice and Secondary Care: Working Better Together – is a practical resource for Integrated Care Boards (ICBs) that sets out a series of recommendations and over 50 examples where local collaboration has helped reduce unnecessary workload in both clinical settings.

Full detail: Delivery plan for recovering access to primary care

See also:

• General practice and secondary care. Working better together
• Delivery plan for recovering primary care access: what you need to know | NHS Confederation
• Press release: Patients to benefit from faster, more convenient care, under major new GP access recovery plan

Government must restore doctor-patient relationship to the heart of general practice, say MPs

House of Commons Committee

MPs accuse the government and NHS leaders of failing to heed the evidence on the importance of continuity of care, hastening the decline of a uniquely important relationship between a GP and their patients, in the midst of an acute and growing shortage of GPs.

• Read the Full Report
• Read the Report Summary
• Find all publications related to this inquiry, including oral and written evidence

The wide-ranging report on the future of general practice urges Ministers and NHS England to acknowledge a crisis in general practice and set out what steps they are taking to protect patient safety.

MPs warn that seeing your GP should not be like phoning a call centre or ‘booking an Uber driver’ never to be seen again and note that care based on a doctor-patient relationship is essential for patient safety and patient experience. The report sets out steps to reverse the decline in the continuity of care, making it an explicit national priority with a new measure requiring GP practices to report on continuity of care by 2024.

However, this will be more difficult to achieve unless the workforce crisis is also addressed. The Committee finds it “unacceptable” that one of the defining standards of general practice has been allowed to erode. MPs also urge NHS England to champion the ‘personal list’ model and re-implement it in the GP contract from 2030.

Full article – Government must restore doctor-patient relationship to the heart of general practice, say MPs

Creating a highly usable and accessible GP website for patients

via NHS England

This guide is designed for practice managers, primary care networks (PCNs), integrated care systems (ICSs), GP federations and anyone who is looking for guidance for improving general practice (GP) websites.

There are multiple benefits to creating a highly accessible and usable GP website. It will:
• Improve patient satisfaction and experience of using the GP practice, making it more likely they will return and use digital tools
• Ensure patients are signposted to the correct place for their needs, reducing wasted patient and practice time
• Reduce the risk of adding digital inequalities to existing health inequalities
• Remove access barriers for patients with disabilities, as well as making your website legally compliant
• Create a place where patients can effectively self-serve, thereby:
o Reducing the burden on receptionists and clinical staff
o Empowering patients to manage their health and care

Full detail: Creating a highly usable and accessible GP website for patients

Next steps for continuity of care

The Health Foundation

General practice is facing significant and multiple challenges, driven by a perfect storm of COVID-19, GP shortages and workload pressures. The impact on patients is obvious – and this is reflected in dramatically falling satisfaction levels. The recent Fuller report offered a clear vision of the future primary care system, including the fundamental ingredients that need to stay, where change needs to happen and what can enable that change.

One of those fundamental ingredients is continuity of care. This article explores not only about what it takes to improve continuity in practice now, but also the opportunities for how it can be a central part of modern general practice in the future.

Full detail: Next steps for continuity of care: practical learning in light of the Fuller report

See also:

• Next steps for integrating primary care: Fuller stocktake report | NHS England
• Continuity of Care Toolkit | RCGP

GP patient survey

GP Patient Survey: National report: 2022 survey | Ipsos MORI

The GP Patient Survey (GPPS) is an England-wide survey of patients aged 16+. It provides GP practice-level data about patients’ experiences of general practice. Ipsos administers the survey on behalf of NHS England. This report sets out the national headline and summary findings for the 2022 GPPS survey.

The proportion of patients reporting a good overall experience of the GP practice decreased to its lowest level for five years (72.4 per cent) – a 10.6 percentage point decrease compared with the 2021 survey (83.0 per cent). This had steadily declined from 2018 to 2020, followed by an increase in 2021.

• Full report: GP Patient Survey: National report
• More detail: GP Patient Survey
• Headline findings: National infographic

General practice on the brink: how did it get there?

General practice is on the brink, and policy-makers, clinicians and patients seem to know it. But how did it come to this? At the start of a mini series of blogs on general practice, this article reflects on how its problems came about and what lessons can be learnt from them | Nuffield Trust

The article explains how a combination of increased demand, staff burnout and deteriorating patient experience are threatening the stability of general practice.

Sitting at the heart of low public satisfaction with the NHS – now at a miserly 36% according to the recently published British Social Attitudes survey, the lowest level recorded in 25 years – is frustration with access to GP appointments. Two-thirds of people who were dissatisfied with the NHS said that this was due to waiting times for a GP or hospital appointment.

Full detail: General practice on the brink: how did it get there?

Also within this series from Nuffield Trust::

• General practice on the brink: what should reform look like? 
• General practice on the brink: what’s needed to implement change? 
• General practice: case studies of GP organisations working at scale to deliver access and continuity

Changes in public satisfaction with GP services in Britain between 1998 and 2019

Aljohani, M., Donnelly, M. & O’Neill, C. |  BMC Primary. Care | 23, no. 83 (2022) | https://doi.org/10.1186/s12875-022-01696-w

Between 1998 and 2019, the structure and process of general practitioner services in Britain underwent a series of reforms and experienced distinct funding environments. This paper examines changes in satisfaction with GP services over time against this backdrop.

Data were extracted from the British Social Attitudes Survey for the period 1998–2019. Results showed sustained and significant changes in satisfaction coincided closely with changes to the funding environment. Distinct patterns were evident among sub-groups. Satisfaction appeared to fall more sharply during austerity for low income groups, older people and people who had fewer formal qualifications/years in education.

While a series of policy initiatives were adopted over the period examined, public satisfaction seemed to move in a manner consistent with levels of government expenditure rather than exhibiting distinct breaks that coincided with policy initiatives. As services recover from the pandemic it will be necessary to invest in a significant and sustained way to rebuild public satisfaction.

Full paper: Changes in public satisfaction with GP services in Britain between 1998 and 2019: a repeated cross-sectional analysis of attitudinal data

Patients’ preferences for telemedicine versus in-clinic consultation in primary care during the COVID-19 pandemic

BMC Primary. Care 23, 33 (2022). https://doi.org/10.1186/s12875-022-01640-y

The Hybrid Patient Care system integrates telehealth and in-clinic consultation. While COVID-19 increased telehealth use, healthcare providers are still seeking the best combination of virtual and in-clinic consultation. Understanding patients’ tele-consultation-related preferences is vital for achieving optimal implementation. The discrete choice experiment (DCE) is the stated preference technique for eliciting individual preferences and is increasingly being used in health-related applications.

The study purpose was to evaluate attributes and levels of the DCE regarding patients’ preferences for telemedicine versus traditional, in-clinic consultation in primary care during the COVID-19 pandemic, in order to facilitate successful implementation.

Mozes, I., Mossinson, D., Schilder, H. et al. Patients’ preferences for telemedicine versus in-clinic consultation in primary care during the COVID-19 pandemic

Eight ways to improve your waiting room

via First Practice Management

With the announcement of the lifting of Covid restrictions imminent from the UK Government, more patients will eventually be returning to practices. Research from Healthwatch shows that patients often find waiting rooms stressful; a quick search on social media for “doctor’s waiting room” will reveal people complaining about long wait times and uncomfortable surroundings, among other things.

This blog explains that with some time, effort, and a modicum of investment a welcoming and relaxing environment can be created that will keep patients, staff and inspectors happy.

Full detail: Eight ways to improve your waiting room