A 21st century health service: fax machines, print outs and misinformation

I recently moved 8.5 miles across London. Along with all the other joys of moving house, I’ve needed to change GP surgeries too. This was my experience: and it wasn’t good.

As a patient, I need to know which surgeries are near me, so that I know where I can access healthcare services

My first task was to try to find a GP surgery. I knew of at least 2 different surgeries on my new door step, which presented me with the paragon of modern public service delivery: choice.

But how do you choose a GP practice in a market with asymmetrical information? The World Wide Web, of course.

Step in NHS Choices; my one stop shop for NHS care information. You know, except all those other NHS websites out there1.

NHS Choices told me what I wanted to know: which surgeries are nearest to me, and - in some of the most confusing ways possible - how good they were.

As a patient, I need to register with a GP surgery, so that I can receive healthcare services

I’d found a GP surgery I wanted to register with2 so next, I needed to actually register!

I could have physically visited the surgery, collected a paper form, and dutifully filled everything in by hand. But this is 2016, and my surgery apparently offered the ability to register online, so that’s what I tried to do.

In this quest for digital fulfilment, I was first presented by this:

My local GP's website

Maybe I’ve been spoilt by central government’s continuous push towards a single domain, and it’s award winning design, but this website was not what I was expecting.

Not only did this website not look anything like an NHS website, but it was also hosted on a private domain: .co.uk in this instance, rather than the more predictable nhs.uk.

My first impression of this was confusion and alarm. I had no confidence in who was running this site, whether I could access NHS services through it, and no way of knowing what would happen to my personal and healthcare information they were asking me to hand over next either.

Alas, I chose to trust the veracity of the information on the NHS Choices website I’d come from, and I pushed ahead with the registration form.

This wasn’t a redesigned service that might be analogous in quality to something that meets central government’s Digital by Default Service Standard - it was merely a digital version of the paper form - but at least it was appropriately secured over an HTTPS connection.

Form completed, I pressed submit.

As a patient using online services, I need my online services to work!

Then I waited.

As instructed, I waited up to 48 hours for my registration to complete. I should then have been able to register for my online account where, for this surgery and this surgery only, I can book my appointments and manage my prescriptions online. Fancy.

Except I couldn’t. It couldn’t find my details.

I was under no illusions here. I knew the online form I submitted was very unlikely to be plugged into an automated process - someone was probably going to rekey that information manually - and so I figured I should give it another couple of days.

So I waited. Another couple of days passed - and still the system could not find my details.

Finally, I gave in and cost the NHS an additional £2.683; I called the surgery.

Quelle surprise, the surgery had no record of me. Luckily, the receptionist I spoke to took pity on me and booked an appointment for me anyway, I just needed to fill in a paper form when I arrived (and thus increasing the cost of this transaction with the NHS again).

As a patient, I need to know which surgeries are near me I can register for, so that I know where I can access healthcare services

I said earlier NHS Choices had told me everything I wanted to know. But it didn’t tell me everything I needed to know.

In between booking an appointment and physically seeing a GP, I came to a realisation: GP surgeries have catchment areas. I didn’t know if I was in the catchment for this surgery; if I wasn’t, I’d have to start over again.

So back to NHS Choices I went. As it turns out, the NHS Choices website shows you surgeries near you, but it doesn’t just show surgeries near you that you’re able to register for. Instead, it shows everything. As a potential patient, that’s not useful. It’s a good job this surgery let me register anyway.

As a patient moving GP surgery, I need my data to be accessible to my new GP, so that I can continue with existing diagnosis and treatment plans

It’s fairly standard practice to need your medical history transferred when you change surgeries. Whilst that’s an undeniable fact, the process of moving that data between surgeries doesn’t seem to know how to cope with it.

You normally have to register to get your file transferred. In this case, I hadn’t been able to do that until the day of my first appointment, so I needed an alternative.

I was advised to call my old GP and ask for my files to be emailed to the new surgery. On calling my old surgery, I encountered “computer says no”.

My old surgery couldn’t send my files by email; in fact, they couldn’t even give me my files. What they could do is fax a summary of my files to my new surgery.

In order to do that, I needed to get my new surgery to send a fax to my old surgery detailing what they wanted to see. So next I had to call my new surgery telling them I would email them my details, so they could fax my old surgery, so the old surgery could fax them back.

Even better, when I finally sat down in front of the doctor, that fax had been scanned back into electronic format which he could barely read from the screen.

This is the NHS in 2016

It’s taken me over 3 weeks to register and get an appointment with my new GP. To do something as simple as register me for a GP surgery, the NHS has incurred the costs of at least 3 phone calls, a few hours of manual processing, 2 faxes, a few web page views and 1 failed digital transaction.

It shouldn’t be this hard to interact with the NHS in 2016: it could be much cheaper, and should be much simpler.

  1. According to the team at the Department for Health developing the then NHS Alpha, there are around 3,000 NHS websites providing a range of health care services. ↩︎

  2. Alarmingly, this surgery was merely rated “OK”, though this was better than the “amongst the worst” ratings some others had. ↩︎

  3. According to the Digital Efficiency Report, commissioned by the Cabinet Office in 2012, a transaction completed by phone costs government services around £2.83, where a digital transaction costs just £0.15 ↩︎