In the UK we don’t have digital health services in any practical or coherent form. It sounds strange to say this considering how far we are into the 21st Century. This problem is apparent to everyone who has any contact with the NHS, whether you’re a commissioner trying to figure out why people use the NHS “incorrectly” or if you’re a patient confronted with the problems of booking an appointment.
Last week we introduced you to Tracey and showed you how her range of needs relates to a complex system. To illustrate the lack of NHS digital services we thought it might be useful to take you through a typical patient journey, as seen by Tracey.
For the purposes of this thought experiment, we are assuming that Tracey has had a bit of luck and managed to secure herself a new flat in a new town. Tracey has decided that this new start is the point where she can begin to manage the really obvious things in her life. To do that she is going to need some support from local services.
The first step in this is for Tracey to sign up for a GP and dentist in her new area. Tracey doesn’t know anything about her new home, it was the only flat that was available. A quick search on the internet takes Tracey to NHS.uk which appears to have a comprehensive list of GPs and dentists in her surrounding area. It also has reviews for each of them.
Deciding that the closest one is probably the easiest Tracey faces one of the first problems. There is a phone number for the practice but no link to their website. Another search brings up the practice website which says that patient registration is too complex to be done online but if you phone the practice they can post the form to you.
Returning to the NHS.uk Tracey notices that on the overview tab there is a link that says “download registration form”. This provides a PDF of the standard NHS registration form. Tracey can’t complete the PDF on her phone so needs to find some way to print it out and then fill it in by hand.
The form doesn’t require much complex information, her address and her previous GP practice. After filling the form in she carries it to the practice and presents it to the reception, along with her ID. The practice reception then tells her she also needs to complete, by hand, a new patient form and arrange to meet the practice nurse for an assessment. As online appointment booking is only available to existing patients the appointment needs to be booked by phone.
Finding a dentist is a similar experience. Some dental practices have links to websites on NHS.uk, some don’t. All of the dentists, local to Tracey, require her to book an appointment to go to the practice to complete a registration form, by hand.
This isn’t an unusual process for anyone moving to a new area. Simple registration with services requires a lot of handwriting and many more physical visits than you would expect. In all cases, the information required to register with a service is not that complex.
Creating a universal registration system for GPs and Dentists is technically simple. Implementing this would be considerably cheaper than the effort of both practices and patients who have to fill in forms and then type those forms into other systems.
Although this has focussed on NHS.uk that is a bit unfair. The reality is that accountability for local services is split across local Clinical Commissioning Groups, GP Practices, GP practice federations, NHS community services and NHS acute providers. Tracey, like most of us, has no idea who all of these are and there has been no attempt to create a single local web presence to manage simple things like registration.
There are a number of reasons that the NHS has failed to resolve this. The most important being its approach to digital. If you have spent any time around the NHS and digital you will see a blindness to simple solutions. An unhealthy interest in cutting-edge AI and technology fads means the easy is often ignored.
The interest in buying fully formed solutions means that little is done to resolve simple things that can improve the patient experience. This also means that there is little strategic focus on how fully formed solutions work together. As a result, the process for the NHS to identify a problem and get itself into the position to create a solution (or more usually buy a solution) can take years.
The NHS also sees the web as primarily a medium to broadcast information rather than a means to provide services. If you visit any NHS organisation you will see that all web assets still sit within the communications function.
The NHS has to fundamentally change its approach to digital. It needs to recognise that solutions can’t always be bought. It needs to see that building a quick solution that works, to some extent, is better than waiting years for a complete answer to appear from nowhere. It needs to see that people expect the web to be a service rather than a collection of websites.
Tracey sees all of this just through spending a few days trying to find a GP, everyone who works in the NHS sees this because they are not immune to the digital changes that have happened in society. At some point this needs to be seen by organisations as well.