Booking is fundamental to how healthcare is delivered

The majority of care in the NHS is carried out between a patient and a professional. Most of the time, that’s scheduled using appointments. Getting healthcare requires having appointments, and having appointments requires booking appointments, so booking is utterly fundamental to the way healthcare is delivered.

Booking is much more complex than just seeing a GP – patients can directly access many other services which do not require a GP. This isn’t always obvious nor easy, and that can lead to people booking with their GP by default.

  • For 1 in 6 GP appointments the patient would have been better served by being directed to someone else in the wider primary care team.
  • Of patients who couldn’t get an appointment or were offered an inconvenient appointment, 9.9% of reported going to A&E or to a walk-in centre instead.

Booking provides an opportunity to guide users directly to services, allowing GPs to spend more time on real clinical care rather than guiding patients through the healthcare system.

There are many routes into healthcare

The traditional model for healthcare has the GP as a gatekeeper. Whenever a person needed healthcare they went to their GP who guided them through the system.

For diagnostic appointments, that’s completely appropriate – that’s the core of what general practitioners do. List-based primary care is an essential part of the healthcare system.

For other types of appointment, when the patient knows exactly what they need (for example getting a seasonal flu vaccination) it can be an inefficient approach.

GP practices offer more than GP appointments

As part of our efforts to keep on top of the demand for healthcare, GP practices have become larger, introduced more types of practitioner and added some services traditionally limited to secondary care. We’ve also introduced other specialised services like sexual health clinics which are available directly to the patient. That means that today there are many ways for patients to access healthcare without ever seeing a GP.

We currently direct patients to their GP for everything

These changes risk exposing the underlying complexity of how the NHS is structured to the patient – we’re asking them to navigate it without the help of their GP. All too often our current online offer breaks down into two options:

  1. Tell the patient to “visit your GP” – this is the way many NHS webpages are written. Where the GP is just acting as an intermediary, this can be frustrating to the user, and wasteful of the GPs time, time that would be better spent with patients with clinical needs.
    before
  2. Tell the patient to work out how to find and access the right service by themselves, putting the burden of understanding how healthcare is delivered onto them. For example:

“In some areas, midwives can give a flu vaccine at the antenatal clinic, while in others you will need an appointment at your GP practice. Some community pharmacies now offer flu vaccination on the NHS.”

This puts the onus on the patient to find out how they should get the vaccine. If that’s difficult, they’re likely to visit their GP or give up entirely.

There needs to be a new option – we need to be able to direct people to the right service first time. When we point someone towards a service, we should understand how and where that’s delivered, and make it simple for the user, for example:

In your area, flu vaccinations are given at Cross Street Pharmacy. These are carried out between 13:00 and 17:00 Monday to Friday and you can book an appointment now.

Service-aware booking could reduce load on GPs

A service-aware booking service – one that knows how flu vaccinations are delivered in any area – could reduce the load on GPs, freeing up the portion of GPs time currently spent guiding patients through the health system. That’s good for everyone.

after

Clearly this won’t achieved overnight. To do this will require:

  • having a register for services which can look up how to access a service for a particular person or location
  • making it simple to book an appointment for that service

NHS 111 caters for urgent care, and it can book patients directly into the urgent care service they need. In order to do that they had to build a directory of services and their clinical capabilities. The 111 operators don’t have to worry about how a service is delivered as the system does that hard work for them. The same should be true for routine care.

Booking is a foundation for other services

Because so much of health relies on booking and it’s used everywhere, it’s a foundation for building other digital services.

Enabling action-oriented content

From our research with patients, we’ve learned that they prefer information pages that are action-oriented, pointing users towards actions. Rather than telling people to “see your GP”, there is an opportunity to direct them to “get a flu vaccination” or “go for diabetic eye screening”.

Enabling new user-focused products

diabetes planner prototype

Booking is a foundation of ideas like the planner we’ve been prototyping. In the prototype, we bring together appointments, prescriptions and content in a way that’s tailored for someone with type 2 diabetes. It includes three types of service appointment, none of which are with a GP. Better directing people to relevant services would be beneficial to patients; even better in future would be providing context around these appointments, things like:

  • When are you next due an appointment?
  • Do you have one of these appointments booked?
  • When was the last time you had one of these appointments?
  • What was the outcome of your last appointment?

Services like this one could be the definition of a more joined up healthcare service.

Helping users manage their conditions

We’ve learned from talking to people with type 2 diabetes that the way they deal with the health system is very fragmented – they hear from one hospital about eye screening, another about foot checks and so on. The burden is again on the individual for managing all the different channels – that makes it very easy to miss something. The benefit of products like the diabetes planner is that it brings everything together, helping the patient keep on top of everything they need to do.

Improving uptake of prevention programmes

Making it simpler for the patient to understand and attend screening appointments helps actually deliver prevention programmes recommended by policy makers. For example, Clinical Commissioning Groups create local pathways recommending eye screening programmes for certain type 2 diabetes patients. This is a way of reducing the risk of blindness – ultimately resulting in better health outcomes and saving money.

In order for eye screening to be effective, there should be high uptake of that service. Local NHS organisations spend money marketing services like these to drive uptake. We could help them drive uptake by directing users to these services in context.

Booking is only the first part of a digital transformation

Booking could be part of a wider transformation in online health:

  • action-oriented content that moves away from “visit your GP” in favour of booking specific services
  • user-focused products like diabetes planner which will help users manage conditions
  • enabling the public to find and book services without needing to know the details of how that service is delivered

Booking is a good place to start as it can hide the underlying complexity of the health system, directing users more efficiently to the most appropriate place. It is a foundation on which other fantastic services can be created and the starting point for a wider digital transformation.

2 comments

  1. Comment from Bernard Baker

    the strategy looks good but has wider implications e.g. services provided by Hospitals and monitored by GP’s e.g. certain blood tests given to monitor certain medicines e.g. methotrexate cannot be dealt with by the GP and involve queuing for up to an hour or more to get a blood test. This is extremely frustrating for patients as linked to parking problems can mean 2 or 3 hours out of a day for a 5 minute blood test

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  2. Comment from Becky Smith

    Totally support the vision and articulation of it. Just a few thoughts.

    I wonder about where choice fits in – where it maybe more convenient to go to a location closer to your place of work for podiatry or eye screening.

    Currently 111 is not patient facing and getting the right information on services from a patient perspective may need different questions to be asked of the system.

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