‘General practice’s digital front door still has too many locks for patients’

Dr Reva Gudi reflects on a patient encounter that highlights how fragmented digital systems are leaving patients to do the joining up themselves

My patient Derek and I were peering at his phone, mid-consultation.

‘Do you see what I mean, Dr Gudi? I’m not a technophobe, but you can see why I want to tear my hair out at times!’ And yes, I could see. He told me this during a recent appointment, with the quiet emphasis of a man who has said it several times recently and feels it bears repeating, to his doctor. I think he thought I could do something about it.

Prior to retiring five years ago, Derek ran a department. He managed spreadsheets. His grandson often calls him for Wi-Fi help. He was not tech-illiterate, which made what he said next rather harder to dismiss.

He told me he had spent 41 minutes on hold trying to confirm an outpatient appointment. The letter had told him to use the portal. The portal had told him his account didn’t exist. The phone line had told him to use the portal. He had, eventually, reached a woman named Sharon, who resolved it in ninety seconds. He spoke of Sharon with a reverence well deserved.

I see Derek every few months. He is 72 years old, with well-managed hypertension. He is the kind of patient who arrives prepared with questions written down, readings recorded. A man who takes his health seriously and expects the system to meet him halfway. What he described, though, was a system that had made him feel that being digitally savvy and navigating our healthcare system smoothly were not, turns out, the same thing. ‘Frustrating’ was his direct quote.

For the record, I believe in what digital can do for general practice, and healthcare more broadly. We have revolutionised the way we work, and it is brilliant. We are moving with the times. Remote monitoring, records that follow patients, appointments that do not require hanging on to the phone; I really do applaud the ambition and progress made. What Derek described, though, was something else entirely.

Two apps, a hospital communication platform, text messages from the practice and other health providers. Separate logins. Password rules of mounting absurdity. A dedicated notebook, colour-coded, which his wife had mistaken for a heist plan. Notifications from the NHS App, the pharmacy app, and the surgery text service, each telling him something subtly different about the same prescription.

He had accessed a hospital letter and blood results, which had him confused, and more than a little worried, and so he turned to ChatGPT to make sense of it all. We have spent decades building the infrastructure to put patient records into their hands, but often without the context needed to interpret them. In a way we need to thank AI for so readily filling that vacuum!

He was reassured, up to a point, but was still told to contact a doctor, which is why he ended up in my consulting room, phone in hand. I laughed. He laughed. And then we both sat with it for a moment.

Because I know what my surgery asks patients to do. I know the letter we send, the app we recommend, the assumption baked into all of it, that patients will navigate these tools smoothly, that digital means joined up, that convenient for the system means convenient for the person.

Yes, guilty as charged.

But sitting opposite Derek, I felt the gap between that assumption and reality rather acutely. He got there. He has broadband, a tablet, a colour-coded notebook, and the determination of a man who once managed forty-two people. He is, by any measure, well-resourced for the digital health age.

I think about the patients who are not.

The 78-year-old lady with early memory changes, who misses her portal notification, and misses her appointment. The man who doesn’t have Sharon’s number and puts down the phone after 30 minutes, because he has a job to get to. The young woman with special educational needs who gets lost somewhere between the verification email and password reset. And the elderly gentleman whose daughter is on holiday, and usually manages for him, as English is not his first language.

What Derek described isn’t a digital health service. It’s several digital health services, each speaking fluently to its own organisation and barely at all to the others. And the person doing the work of integration, is the patient. Often an unwell patient. Sometimes an elderly one. Frequently someone who didn’t sign up to be the IT department.

But I keep thinking about the ones who won’t find their Sharon. The ones for whom the friction isn’t a minor irritant but an actual barrier – missed appointments, delayed prescriptions, upset patients, stressed staff and everything else that doesn’t even cross my radar. We digitised the front door and forgot that some people are still looking for the handle.

Encouraging patients to go digital is the easy part. But making sure the experience doesn’t defeat them is the responsibility we haven’t met yet. The technology isn’t the problem; the fragmentation is. And until we fix it, we are quietly, unintentionally, building a health service that works best for the patients who need the least help navigating it.

Mine and Derek’s 10 minutes were up. Well, 20 really, which included a tour of Derek’s phone and a vivid account of what navigating the NHS can at times feel like.

‘Fascinating. Right?’ he said.

‘That’s one way of looking at it’, I smiled, as he left my room. Fascinating, but telling.

Dr Reva Gudi is a GP partner in Middlesex. She is a former clinical commissioner, former non-executive director of an NHS Trust, school governor, and charity trustee.