What helps patients access online services in primary care? Free-text analysis of patient responses to the Di-Facto survey

Problem

The NHS and general practice are increasingly adopting digital services to facilitate access to primary care services. These services can impact both positively and negatively upon patient experiences, and access to digital services is not equal amongst all groups. As part of a wider project (the Di-Facto study) our team conducted a patient survey amongst English primary care practices to investigate patient views of digital facilitation. This work reports the free-text responses from the patient survey to summarise patient perspectives on the use of web-based services.

Approach

The Di-Facto patient survey was distributed to practices in eight clinical commissioning groups (CCGs) in England between 2021-2022. We examined the free-text responses to two questions which asked patients, ‘What can the practice do to help you access the online services’ and ‘Is there anything else you would like to add about online services and the support at the practice to help you use them’. We used a qualitative reflexive thematic analysis based on a six-stage process to analyse the responses.

Findings

3051 patients responded to the Di-Facto survey, and 2246 respondents provided a free-text response. We present our findings in two major themes. Firstly, respondents described how the technology, such as practice website design, confusion over multiple digital apps, data and security and concerns about eConsult offerings impacted on use of web-based services. Respondents also described practice level barriers, such as a lack of or inconsistent provision, which prevented optimal use of web-based services. The second major theme describes what worked for respondents in terms of their interactions with digital services. Respondents described personal and technical barriers that impacted on their use of digital services. Some respondents felt that online services worked well for them, and described what they would use these services for, and provided suggestions describing what would help them access more online services. Other respondents felt that web-based services were not a replacement for face-to-face interactions with a doctor.

Consequences

This analysis of free-text responses to a large patient survey highlights the system, practice, and person level barriers and facilitators to use of digital services in primary care. We will discuss the implications of the results in the design of and access to digital services in primary care.