As technology’s role in healthcare keeps on growing, one crucial aspect of the primary care system, new patient registrations, is an example of an online approach that could become the norm.

Spoiler alert – it’s already happening!

The COVID-19 pandemic forced the health service to focus on helping those most affected by the virus and drove many other queries and appointments online to avoid unnecessary face-to-face contacts.

During this period of more remotely provided care, practices had to deal with the perennial business of registering new patients and an online approach for this was an obvious solution.

Many practices already offer patients the choice of registering online using the official GMS1 form, which does still require a signature, but the latter requirement appears to have the loophole of allowing patients who complete it to use an electronic signature.

Strictly speaking, NHS England’s guidance still asks for an application to be made by delivering a medical card or a signed application form to the practice premises but does not specify a signature written in ink.

However, guidance to patients from NHS England says: “Because of coronavirus (COVID-19), try to avoid going into a GP surgery to register. You can: check the GP surgery website to see if you can register online; call or email the GP surgery and ask to be registered as a patient.”

Consultation

This move towards online registration makes sense but government agencies are now seeking to make more permanent changes as part of ongoing efforts to reduce bureaucracy.

NHS England, NHS Digital and NHSX are embracing the inevitable and have launched a consultation – online, of course – asking practice managers to tell them what is essential in a modernised and standardised approach to registering new people with a GP practice.

Benefits

Managers are realistic about the changes ahead and accept there are potential benefits from an online approach, such as saving time, and that every practice would be collecting the same information.

In addition, if a patient had an official account, this could ask them to confirm that their main details are correct thus saving them from having to input this information repeatedly – e.g., their family history, long-term conditions, medication, height, weight, alcohol consumption, and smoking status.

Nicola Davies, a practice manager in Cornwall and co-founder of the Institute for General Practice Management, says: “It’s like everything that’s online – somebody can do it whenever it suits them most. Online access can make things so much easier for everybody, but there are people who haven’t got this access so we’ve got to have a paper-based system as well and we’ll always need that.”

A standardised online approach could work, according to Helen, a practice manager from London, who says: “At the moment, patients who want to register with my practice can do a lot of that process online already but we still then have to put it on the clinical system manually.”

Around a third of patients still complete registration with the practice using a physical format and 70% digitally, she says, although only digital registration was accepted during the COVID-19 pandemic.

“The only way this new system would save bureaucracy was if it also automatically populated our computer systems,” she explains. “At the moment, our website encourages patients to register through that, but we still have to add them onto our clinical system.

“I’m assuming they [NHS England/NHS Digital] would use something similar to Pinnacle because that’s what they’ve been putting the COVID vaccines on and that links to the Spine.”

Flaws

Any potential new registration system cannot exclude those who may find it difficult to use, such as people who are homeless, illiterate, anti-tech or without access to technology, older patients or blind people, so there would need to be an alternative.

There could also be an issue with a system that prevented personalisation for individual practices. If a practice has a particular Local Enhanced Service (LES), for example, it may wish to include questions that are relevant to helping meet the service.

According to Nicola, local input would be important; she says: “If you do the online process, there needs to be some kind of middle holding box.

“The practice could get a message to say ‘you’ve got five registrations ready to download’; you go into that holding box and look at them and either accept or reject them with a message back to the patient that says, ‘sorry but you are outside our boundary’ or ‘we can register you, but we might struggle to visit you because you’re outside our boundary’.”

Managers are also likely to want a system that is sophisticated enough to point patients towards practices near to where they live.

Helen believes there has to be some form of geographical boundary limitations applied to the process, possibly asking patients for their postcode when completing the online form so the system can then list which surgeries are closest to them to contact.

“Unless they tear up the requirement to have practice boundaries, they’d have to have boundary limitations otherwise we’d have to reject some people,” she says. “This could become horrendously complicated. What you don’t want to do is annoy the patients at the first point of contact by saying ‘you’ve chosen that practice, but you can’t go there’.”

Nicola agrees, adding: “We can’t just accept anyone. If you’re outside our practice boundary and you’re somebody who’s housebound and needs regular visits, we might not be the right practice to register with. You might be better going to the practice around the corner from you.”

Must-haves

Part of the consultation’s aim is to find out what managers think should be included in a formalised online application process.

It’s likely that those managers who take the estimated five to ten minutes’ time to complete the consultation form will recommend it includes everything that is asked for on the current GMS1 form such as name, date of birth, current address, previous GP practice details, NHS number, and previous address.

However, there may be an opportunity to also ask about family history of illness, current medications, long-term conditions, weight, height, blood pressure (if known), and alcohol consumption and smoking status.

Nicola says: “We need to make sure that the online form has mandatory fields built into it so that the patient can’t get any further without filling in the mandatory fields. We don’t need a mobile phone, an email, your height and weight, but those things are all really useful to know.”

Fraud risk?

Some may have concerns about a new registration system being open to abuse, especially as having an NHS number can unlock state benefits.

Helen is not overly worried about fraud, saying: “Your NHS number and NHS registration should never be used as a proof of ID. All it does is prove you’ve been given a number and that you’re registered with a GP in that name.

“If you want to claim benefits, you have to have a National Insurance number. You could potentially get NHS treatment when you’re not entitled to it, but that depends on how efficient the secondary care provider is. Primary care is not allowed to refuse patients.

“It will depend on how efficient the hospital is at determining whether a patient is eligible or not. The potential for fraud is pretty low.”

Nicola adds: “When a new patient wants to register with our practices, we can put the patient demographic information into the computer system and do a search on the Spine and then we can marry the patient up with matching information. For this new system, as they have done for the NHS app, they could ask the person to provide photo ID – a copy of their driving licence or a copy of their passport.”

Hit with the patients?

The kind of system being proposed is likely to be popular with some patients – it would save them the trouble of coming down to the practice and save them time – but not others, who perhaps do not have the same level of access to or experience with technology.

Practices will no doubt see the potential for the new system to save on time and bureaucracy, but comments made on a thread about this issue on Practice Index indicate that they would also want to retain control of the registration process.

As the consultation is now closed, here’s hoping that enough managers took the time to complete it.

Helpful document:

New patient registration and health check policy [PLUS]