How the NHS Patient Partner online booking system is alienating Doctors and failing to help Patients

PULSE So Long Partner Dr Tony Copperfield

This Pulse blog article by Essex GP Dr Tony Copperfield highlights some manifest design failings in the latest “Patient Partner system” being introduced to the NHS to enable Patients who are online to make in-office appointments with their Family Doctor.

It amazes me that the NHS continues to ignore so much published best practice when it comes to working with Patients online. These basic online booking forms might’ve looked interesting back in 2000 but it’s time anyone involved in this dead end project:

> takes this completely free lesson on online interaction with Patients from the Mayo Clinic’s Professor of Primary Care Dr John Bachman MD

> Reads about the clinical validation of interactive Patient history taking tools and the impact they can have on primary care.

> Ponders how out dated it is for Doctors to be continuing to provide undocumented care in 2013.

Here’s a few of my thoughts on the article (I’ve tried to stay with the Ryanair analogy that Dr Copperfield has started with to make my points):

Six of the nineteen patients who had booked appointments didn’t show up. I’m used to the occasional no-show, and the fifteen minute appointment slots we dole out on Saturday are so long that even the most devoted heartsink runs out of medically inexplicable symptoms before they run out of time. Combine these two factors and the result is that I’m always armed with a crossword and some decent music to wile away the longeurs between consultations

I think it’s very clear that it’s the one size fits all policy that’s working against Dr Copperfield’s objectives. When are Doctors going to accept that some Patients – especially the ones who can use the internet to communicate with them – don’t always need to be even seen in their office? Could you imagine if Ryanair just automatically doled out something as unspecific as a 3 hr flying slot to prospective passengers?

Where do you think everyone would want to turn up and fly to? (clue: it’s 3 hrs away and it leaves straight after work on Friday).

Then I noticed something. Every DNA’s name had a small label by its side, showing that the time wasters had booked their time slot online using the Patient Partner system. The all-singing, all-dancing, state-of-the-art, patient-empowering, instantly accessible, twenty-four-seven, three-sixty-five, fail-safe, click the mouse and you’re done Patient Partner system

Dear Dr Copperfield please accept a complimentary invitation to join my mHealth for Professionals course on Sunday at Health 2.0 Europe as it’s critical that as a provider of healthcare in 2013 you appreciate that there is nothing “all singing, all dancing, state of the art” about a system that lets your Patients pick an available appointment in your schedule: Tens of millions of people use Google’s online Calendar and get this functionality and more for free.

If Ryanair deployed a system as primitive and out of date as the NHS Patient Partner system that GPs are trying to work with their passengers would be booking flights to uncertain destinations (a 930am appointment with a Doctor really isn’t comparable with any specific plane or route), the planes wouldn’t be able to take off as some passengers would inevitably arrive with 2cwt of luggage (your primitive booking system doesn’t let them tell you where they want to go or what they’d like to travel with), very few would have brought their passports (you didn’t give them this information), etc.

One of them rang up to ask why the building was apparently empty and locked up tight before realising that he was standing outside the wrong surgery, the one that we don’t open on Saturdays. ‘If I shoot over now, can you still see me?’, he asked. ‘You know that thing when you book a flight with Ryanair, and then show up at the wrong airport for your flight home? We’re like that. But even meaner.’

The sad thing about this attitude is that Ryanair makes more money by doing this so it’s a vested interest of theirs for Patients to make this mistake. The GP on the other hand is messed about waiting and has to provide the consultation at some other time so there’s not even a financial or energy saving upside.

A simple solution to this might for clinics that expect Patients to observe such location changes might be a SMS closer to the appointment time ensuring that they have the address and appointment time and they have the ability to cancel the appointment via SMS (in case there is a change of plan and they can’t make it etc).

The others probably thought that anything you could get for free with a mouse click without being subjected to a barrage of online advertising or having to uninstall a shed load of malware was worth so little that nobody would be bothered if you changed your mind

I think Dr Copperfield has hit on the fundamental problem with this very basic online engagement process that the NHS is trying to use. In 2013 most people who are online expect more engaging and productive experiences than the NHS is offering them. Clicking on an available time slot is simply not enough especially when Patients have information they want to share with you and by reviewing this information you can more effectively manage their needs.

It’s worth noting that even the very lowest cost no frills airlines have interactive online services that let customers browse their entire range of available flights/prices for months in advance, reserve a seat, buy a bag, arrange airport transfers, pay for a meal, book a bag, submit your passport details, check-in, etc.

From now on, if anybody wants to see me at the weekend, they talk to a human and arrange it on the phone. The Patient Partner button for Saturday surgery is, as of now, greyed out

In the late 90’s the big Airline operators had similar ideas about how their customers should interact with them. The world’s biggest airlines are new low cost airlines that took advantage of this lack of customer insight. Today of course the premium airlines like British Airways not only offer the latest in interactive mobile apps but they’re even equipping their cabin crew with iPads (like the NHS has started doing with ICU nurses).

And there’s no use bleating about it. The GP giveth and the GP taketh away. I gave you this nice shiny new toy and like any good parent I’m confiscating it until you learn to use it properly. Which will be never, obviously

In this paragraph I think Dr Copperfield has summed up succinctly why this naive NHS approach to online services is failing everyone. The hard working frontline of family medicine doesn’t need “shiny new toys” it needs clinically validated tools that have been proven to reduce their workload and enable them to manage the needs of their Patients.

For lessons on how this is already happening in the NHS check out the ‘Surgery CARES’ service being rolled out at the Haughton Thornley Medical Centres.

What do you think?

About 3G Doctor

The Corporate Blog of 3G Doctor
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