Lewisham Patient Online Case study14/08/17

Patient Online

Case study: Delivering Patient Online across forty practices

Lewisham CCG

March 2017

Background

Healthy London Partnership (HLP) Transforming Primary Care programme set forth to organise a pan-London Patient Online project working to increase the utilisation of online services for patients across all London CCGs. Studies have shown that there are benefits to online services for practices, patients and the NHS as a whole, including cost efficiencies and improved access.

London’s vision of primary care is ambitious and is trailblazing in ensuring an improved way of working effectively (general practices with each other and other primary care providers), operating without borders, and in partnership with the wider health and care system. This vision is outlined in the Transforming Primary Care in London: A Strategic Commissioning Framework (SCF) building on NHS England (London) Transforming Primary Care in London: General Practice A Call to Action. It addresses the need to provide a more consistent service for all Londoners through improving coordination of care, access to services and taking a more proactive approach to our patients’ health and wellbeing.

The goal for the NHS is to make digital a key part of health and care services, but as a report from the National Information Board makes clear; this is an opportunity for the public to benefit from digital access to health services and information must be inclusive. Critical to this goal is a commitment to “build better insight into the barriers to digital inclusion”.

This case study will cover how Lewisham CCG was able to ensure delivery of the programme across 40 GP practices with a growth of 6.6%, meaning that over 78k patients across the CCG now have an online account. As of the end of March 2017, Lewisham CCG now has 24.2% of their population registered with an online account, which ranks them number three out of the top five areas in London.

In September 2016, Lewisham CCG had 32.5% of practices with 20% or more of their patients registered for Patient Online. Lewisham CCG aimed to increase this with an aspiration to work towards all 40 practices having a 20% minimum threshold of registered patients who have registered for Patient Online by March 2017. The practices would also be working towards a target to release up to 80% of their GP routine appointments to be available online.

Overall Lewisham increased from 17.7% to 24.3% of patients being registered for Patient Online, equating to approximately 21.5k new activations in the three month active period of the project from January 2017 to March 2017.

How did the project get delivered?

The CCG recognised that in order to get the Estates and Technology Transformation Fund (ETTF) project delivered, it was vital to recognise a shift in the way that practices traditionally offered access to Patient Online, as well as looking at the way service users accessed these. This meant that in order to successfully deliver the required levels of uptake and utilisation at each practice, there had to be a clear understanding of what was being requested from the different staff groups within the GP practices.

It was decided that a support package would be created to assist in the delivery of the project ensuring the same level of engagement with all 40 practices in the Lewisham area.

It was clear that there would be a need for a multi-tiered level of support to be provided to the practices. Some practices would need more support than others and it was agreed that communication and training support was required to include the following main components:

  1. Provision of specialist technical training to practices (delivered by EMIS) to ensure practices have relevant knowledge across the patch on how to fully utilise the functionality of Patient Online, as well as ensuring the technical systems were set up and optimised for Patient Online.
  2. Clinical ‘peer–to-peer’ visits to practices led by a CCG appointed Clinical Lead with the aim of understanding and addressing any clinical concerns that may hinder promotion and uptake. This was also used as an opportunity to share best practice at clinical level.
  3. A financial incentive package for practices to support engagement with the programme and delivery of the associated outcomes:
  4. EMIS training session received by the practice by 31/3/17
  5. Clinical ‘peer-to-peer’ visit held by the practice by 31/3/17
  6. A minimum of 20% of registered patients enabled for Patient Online services by 31/3/17
  7. Visibility of promotional material in practice waiting areas.
  8. Public engagement - communications and marketing campaign to inform patients of the availability and benefits of Patient Online services. The public facing marketing campaigns included:
  9. Go ON Lewisham events – GP Online Services was put on the agenda at the Go ON techie tea party Celebration on Wednesday 22nd February, a well-attended event with over 100 participants. This had representation from the CCG, the HLP staff member and a PPG volunteer member. Some promotional materials were handed out.
  10. Lewisham life Magazine is a borough-wide free magazine, delivered to every household and it featured an article highlighted under the heading: Online GP services and alternatives to A&E.
  11. Advertising was commissioned in the online version of the News Shopper ( which ran in March 2017.
  12. A Facebook campaign targeted by postcode was also commissioned with the aim to increase uptake. A direct link for sign up was included in the campaign enabling direct access to online sign up.
  13. The Lewisham CCG website was updated with a page that provided information and signing up links for Patient Online Services (

How it worked

With a great deal of support and encouragement from the Lewisham General Practice IT (GPIT) Facilitator, all practices signed up to the support package for Patient Online and receivedeither one full day or a half day’s training on all aspects of the Patient Online programme within their clinical system. This ensureda level ofconsistency in approach across all the practices.

Additionally the development of the support package for Patient Online seemed successful as it hit the target for training from system suppliers. This ensured some consistency in approach across all of the practices. Thirty-nine out of the forty practices received clinical peer-to-peer visits; all low performing practices also received a visit from the GP IT facilitator discussing best practice and with practice managers, offering support around admin aspects of the programme processes, promotions and tips.

One of the key elements to support delivery of the project was the development of a weekly update email. The update included a dashboard ofprogress and benchmarkedpractice performanceacross the borough. The practices found this particularly useful to identify where they ranked amongst their peers and how much further work was needed to meet their respective targets. Along with the dashboard, included were some useful hints and tips, and best practice information. Practices welcomed the tips particularly where these had been tried and tested elsewhere by their peers with positive outcomes.A weekly highlight of the top 5bestperforming practices based on total number of new “live” patients was also included whichpromoteda healthy competitive spirit amongst the practices.

Additional efforts were made to target the low uptake practices. These practices had reported a lack of capacity around their Administrative staff to prioritise Patient Online. Taking this feedback into account, additional communications and engagement activities were undertaken to increase patient awareness of these online services in order to increase patient engagement. Additional financial incentives were also offered to all practices for dedicated administration time with the aim to specifically follow up with patients who had an “active” account status, in order to convert these into “live” accounts. There was also assistance with additional Administrative staff resource in waiting rooms, for those GP Practices who were struggling around capacity. They were offered an additional dedicated administrative resource for a couple of days and these people physically went into the waiting rooms to support patients with signing up and in some cases convert their online accounts from an “active” to “live” status.

Why it worked and why Lewisham CCG thought it was important to deliver this project.

As a CCG who was already performing relatively well in this area, Lewisham wanted to build on this position but also to reduce variation, supporting a consistent offer of Patient Online across all our practices. As part of their wider primary care development programme they saw the Patient Online programme as a way of both supporting improved access and experience for patients, as well as releasing capacity within practices.

Communications was imperative both internally and externally. It was important that all GPs, Practice Managers and Administrative staff were aware of the project being proposed across Lewisham. It was equally important to inform patients, to increase visibility for the Patient Online programme as well as to increase utilisation. The main goal was to get patients to not only sign up but to actively use these services. This included the use of targeted marketing through the regular council magazine that is delivered to every household in the borough, the online version of the main local newspaper and postcode specific advertising through Facebook.

Through this multi-faceted approach, Lewisham provided practices with the technical and clinical support to maximise the benefits of Patient Online for practices and patients.

Final evidence showed a significant increase across Lewisham:

SPG Name / CCG Name / RAG / Practice Size / % online September 30th 2016 / % online March 24th 2017 / % Change
NHS Lewisham CCG / G / 321,988 / 17.6% / 24.2% / 6.6%

Figure 2 above showing HLP figures with Lewisham CCG in the top 5 on number of patients with an online account by March 24th 2017. The map shows area levels benchmarking uptake across London CCGs.

Amount of practices with over 20% of patients registered online by March 24th 2017:

HLP figures for Lewisham CCG ranked it 1st in the top 5 CCGs in London based on the percentage of practices with over 20% of patients registered for GP Online Services by March 24th 2017. The map shows the levels for each CCG.

For additional information contact Thauzeni Anorld Nyambara, GP IT Facilitator Trainer

Supported by and delivering for London’s NHS, Public Health England and the Mayor of London / 1