Five steps to achieving the online access DES (1 CPD hour)

For 2013/14, the NHS England has designed and published an enhanced service to improve online access for patients. This enhanced service has three main facets to focus upon:

• enabling patients to book (and cancel) appointments using online services (single payment of 14p per registered patient)
• enabling patients to use online services to order repeat prescriptions (further single payment of 14p per registered patient)
• registering (by issuing login details) at least 5% of the practice’s patient population for online access (flat rate payment of £985).

You may have noted in consecutive patient surveys that the demand for the ability to book online appointments is steadily increasing and there can be many other advantages in enabling this service for your practice population.

Potential benefits include a reduction in the workload pressure on your reception front desk and telephone systems as well as the freedom for your patients to select an appointment or request repeat medications 24 hours a day, seven days a week, whether your practice is open or closed.

If you also combine this functionality with setting up appointment reminder text messages to patients (for more on this, see this case study), you could also potentially reduce the number of DNAs. Patients can cancel their appointments online if they cannot attend their appointment.

Most of the major GP system suppliers already have the facility to enable online access but it requires practices to decide to switch this on. Recent statistics suggest that although 98% are potentially ready to offer online services, only a third have enabled the functionality.

This DES does not currently cover offering patients online access to their own medical records, although the specification says it will be developed and adapted for the business year 2014/15 to take into account the Government’s commitment to offering safe online messaging and access to records.

This five-step guide should go some way to helping you achieve the full potential of this enhanced service.  

1. Plan your workflows

It’s one thing switching the functionality on, it’s another to ensure that it is configured and working correctly. With online appointment bookings the workflow is relatively straightforward and works in real time, meaning that when your patient books an appointment online it is automatically updated in your clinical system so that there is no risk of double booking. The main decision that needs to be made by practices is how many appointments they want patients to be able to book at any one time, and which sessions and appointment slots should be allowed to be booked online. Using EMIS Web, for example, configuration options can enable the practice to decide which appointment(s) should be available to be seen online for patients to book directly.

If you are going to enable online prescription requests then you need to understand what your process will be within your practice to manage these online requests. The first thing to do is to analyse what currently happens in your practice. Usually the process goes something like this:

• The patient hands in right-hand side of the prescription slip to reception.
• Reception processes the script by either printing out request for the GP or placing it in the GP’s in-tray.
• The GP verifies and signs the prescription.
• The prescription is placed in reception, either for the patient to collect or to be sent to pharmacy.

A workflow for processing online requests would go something like this (using EMIS Web as an example):

• The patient logs in online and requests medication.
• The GP reviews prescription in Workflow Manager – Medicines Management, and issues the prescription.
• A prescription is printed out for patient to collect from reception (or goes direct to a pharmacy if the Electronic Prescription Service (EPS) is set up between practice and pharmacy)

You can see that the way clinicians receive and issue medications will move from a paper-based system to an electronic one where prescriptions will be processed using Workflow Manager. Therefore this must be addressed as a training need for clinicians in your practice. Most practices will already be using Workflow (or whatever solution your GP IT system offers) for lab results, so the learning curve for this additional process should be relatively smooth.

2. Set up your system to provide online services

Once you have planned your workflows, you will need to ensure that your GP clinical system is set up correctly so that online services are available for your patients.

Using EMIS Web as an example, the settings for the online services are called Patient Access (if you can’t find them, go to System Tools > EMAS Manager > EMIS Menu). Ensure that you have adequate administrator rights for setting up your GP clinical system. These rights are usually assigned by default to your senior administrator or practice manager.

What you need to enable for this enhanced service are the sections for appointment booking and repeat prescriptions. 

You will need to decide which appointment sessions and which appointment slots you wish to make available online to patients.

Using EMIS Web as an example, the configuration options are under the appointment module (Appointment Configuration) where you can select which appointment slots are allowable for online booking. You can also set up your appointment session templates in the same way.

There is also the functionality within EMIS Web to configure each user to be enabled (or disabled) for online appointment booking so that the practice can be in full control of opening up and configuring the online appointment access. For more on offering online appointments, why don’t you take Pulse Learning’s 

Five steps to managing an online appointment service module. 

3. Test your system

The best way to test the system is to register a ‘test patient’ for online services. In EMIS Web, this is under Registration Module > Edit Patient > EMIS Access. This allows you to select the services you wish to enable for your patient and print out the relevant log-in codes.

Once you have the codes, register an account for the test patient online and create a password. The level of security used to log in is similar to online banking with several identifiers and a password required to set up the account.

When you have set up the account, you can log in and see the view from a patient perspective, book online appointments and see how they are reflected in the appointment book as well as order repeat prescriptions and test out how your workflow would work.

It is usually a good idea to go through this process with your practice team and it also would be worth showing this as an example to your patient participation group (PPG).

4. Train staff to run the system 

Having set up the system and experimented with the functionality using a ‘test patient’, you now need to get your staff on board to create the personalised online booking codes for patients to start using the system.

This is an important part of the enhanced service as the third part of the payment is only achieved if you issued login codes to 5% of your practice population and enable them to login to the service by 31 March 2014.

There are many ways to do this and thinking through your practice strategy for this is recommended. You may also want to get the views of your patient participation group. At our practice, we used a variety of methods to allow patients to obtain their booking details and the most important aspect to consider is that the patient in front of you is who they say they are.

Key points would be to only issue codes face to face so that you can confirm who you are issuing the login details to, as well as asking for photo ID to confirm that the patient is who they say they are.

As good practice, we also stressed that, for confidentiality reasons, we would only issue online access codes to patients aged 16 or over.

5. Market online services to your patients

Now you have everything set up, the next step is to ensure your patients know about the service.

The default gateway that you should direct your patients here for EMIS practices or here for TPP SystmOne which are both secure sites. These details will usually be printed on the login details sheet that you initially give to patients.

To achieve the DES payment you need to offer online access via the GP clinical system, and not directly from the practice website. The DES won’t be paid for practices who offer repeat scripts or online appointments via their website rather than via their clinical system. However, you can always provide a link to the GP system from your own practice website, if you have one, to make it easier for patients.

There are also lots of other ways to get the word out, from posters around the practice or in waiting rooms and consulting rooms through to advertising online access on your patient information screen in the waiting room. If you have a website or social media accounts (e.g. Twitter) for your practice, these can also be used to inform your patients. 

Another strategy that could improve uptake is to routinely offer the online codes to patients when they attend for new patient checks or attend for annual reviews or flu vaccines.

Once the ability to produce the online codes is available and your practice staff are comfortable running the system, you may find that they will start informing patients automatically. Getting your reception team to take ownership and look at ways to improve uptake could be a win-win as they should notice the reduced traffic from walk-in patients and calls into the practice.

One of the other innovative ways that we found useful to advertise this service was to have an A5 poster stand in each consulting room on the desk in view of the patient for the patient highlighting the online services.

With the advent of patients using various devices such as smartphones to access the internet, EMIS have also created an app which enables patients to securely book appointments or request repeat medications from their iPhone or Android smartphone, as well as the option to do the same via a digital TV. Tell patients they can find the app in the Apple and Google Play stores if they’re interested.

Dr Osman Bhatti is a GP in Poplar, east London, and a member of the EMIS National User Group (NUG). 

Recommended reading

Find the full specification here.

The RCGP have put together the Patient Online Roadmap that explains the reasoning and principles of online services for patients to support their healthcare.