The NHS Long Term Plan, published in January 2019, commits to every patient having the right to be offered digital-first primary care by 2023/24. The various commitments that make up this plan have been introduced gradually every year through the GP Contract since 2019/20, which means GP practices should, among other new requirements, now offer an up-to-date online presence and an NHS GP profile page and provide all patients with online access to their GP medical record.

Currently, front and centre of NHS England’s activity is a drive for all practices to offer every patient in England access to a digital-first primary care offer. In short, this means practices are required to “offer and promote” to their patients (and those acting on their behalf) the following:

• An online consultation tool
• A video consultation tool
• A secure electronic communication method
• An online facility to provide and update personal or contact information

All about choice

While some GPs and Practice Managers are in favour and some are against this move, the idea of providing patients with a choice has led to NHS England pushing through the contractual change.

An NHS England spokesperson told Practice Index: “We understand that digital isn’t the best route for everybody. That’s why the digital-first requirements are designed to be offered alongside, rather than as a replacement for, other access and communication methods, for example, telephone and face-to-face contact. Plus, of course, these requirements are all subject to existing safeguards for vulnerable groups and third-party confidentiality.”

The NHS England spokesperson pointed to digital-first offering the ability for primary care to provide for the needs of a local population flexibly, enabling the redesign of care pathways with digital tools. It aims to ensure that people can access appropriate health and care services in a way that meets their needs – this may include telephone, photographs and video consultations, depending on the patient’s condition, the clinician’s relationship with the patient, and their preference.

GP Contract requirements at a glance

Given the contractual need to offer the four different digital-first services and the benefits listed above, what are the actual requirements? Full information can be found on the NHS England website (click here to read more), but at a glance, here’s what practices need to provide:

• Online consultations: The 2023/24 GP Contract states that all practices must offer and promote to patients the ability to access and use an “online consultation tool”, defined as a software system that, as a minimum, enables patients to make contact with their practice online and seek health advice, describe their symptoms, ask a question, follow up on a previous issue, or make clinical/administrative requests.
• Video consultations: Practices must offer and promote to their patients the ability to participate in consultations by video call. Software to enable video consultations should be free for the patient to access or download and use on their own device.
• Secure electronic communications: Practices must offer and promote a relevant electronic communication method that allows both the practice and the patients to communicate digitally with each other in writing.
• An online facility to provide and update personal or contact information: An online method must be provided for patients to inform the practice of their address, contact details or other demographic information and to tell them of a change to any such information.

Potential practice benefits

NHS England talks at length about the benefits that the latest round of digital care delivery will afford GP practices. The hope is that by giving patients the ability to engage electronically and attend online consultations, practices will see a release in pressure on staff and resources more generally.

NHS England told us that, based on implementation so far, benefits are most likely to be achieved when the practice has actively adapted the use of the tool to meet local needs and has considered and adjusted workflows, rotas, appointments and communication with patients to support the new ways of working.

“We recognise that practices need time and support to undergo this change process,” the spokesperson told us. “There is no ‘one size fits all’ model, and practices are encouraged to co-design an appropriate model with patients and staff that meets local needs.”

Buying the right digital tools

Crucially, the exact tool to be used and the precise functionality provided beyond the minimum is for practices and commissioners to determine. To ensure the use of assured and compliant products in general practice, the Digital Care Services catalogue has been established. If a practice chooses to use software for digital capabilities outside the catalogue, it is the practice’s responsibility to demonstrate that the software meets the same or equivalent standards. Incident and contract management for these products would also be the practice’s responsibility.

When buying software, practices must:

• Utilise software that meets the necessary quality standards
• Note that software is considered appropriate if it meets the requirements of the Primary Care (GP) Digital Services Operating Model – click here to read more

The relevant standards include, but are not limited to, technical cyber security with encryption measures, authentication protocols to verify patient and staff identities, information governance to ensure compliance with data processing standards and patient proxies, and patient/clinical safety.

Other factors to bear in mind when successfully delivering digital-first care include:

• Managing the change: Digital transformation works best when there is a clear understanding of why new technology is being introduced, a planned strategy for implementation, and knowledge of how new technology will benefit the end user.
• Ease of use is crucial: Practices should make sure patients are surveyed to determine whether or not the software is user-friendly and working as it should.
• Practice staff need to be on board: A platform and provider with good training and aftercare is essential.
• Try before you buy: Practice Managers should arrange demonstrations and discussions with various providers to ensure they get the right product for them. Involve multiple stakeholders in these demos.
• Assign a tech champion: Practices should consider assigning one person to address any queries in real time.
• Signpost often, everywhere: Make sure signposting – via as many digital and analogue methods as possible – is accurate to help patients understand what they can expect. One GP we spoke to suggested building an FAQ document to help practice teams deal with enquiries and complaints, with the document held centrally and available for editing so that additional points can be added over time.
• Regularly assess: Regularly canvass opinions through stakeholder surveys and consider adding these to your practice’s patient satisfaction survey as well as staff feedback forms.
• Don’t forget safeguarding: Safety is one of the critical concerns practices need to manage around video and online consultations. Indeed, patients should expect effective safeguards to be in place to protect them, and this is a line of enquiry that CQC inspectors can take when questioning practice staff about digital consultations. To assist practices, the CQC has published a handy mythbuster guide to online and video consultations, and to receiving and storing images – click here to read more.

Join the conversation

What do you think about the digital-first primary care requirements? How is your practice implementing them? Have you noticed any benefits yet? What tips can you share with your fellow Practice Managers? What questions would you like to be answered when it comes to rolling out these new services? Join the conversation by commenting below or head to the Practice Index Forum to have your say.

Useful resources:

Digital Transformation Bundle – Practice Index Training
Understanding Prospective Record Access – Learning Package
Access to medical records [PLUS]