A fragmented, digital primary care: are you alienating your elderly patients?

As the NHS becomes increasingly fragmented and digital, Practice Business explores whether elderly demographics are being left behind by online primary care – or whether this stereotype is unfair

“I often wonder what my 93-year-old grandmother would have made of calling one number for the community nurses, another for her medication or a minor illness assessment whilst also navigating the maze that is hospital contacts from a recent stay. I am not too proud to admit that I am beginning to struggle with the increasing fragmentation of services and often seek our marvellous medical secretaries’ advice.”

In an article published by GPonline, Heike Burnett, practice manager in in East Grinstead, West Sussex, voiced her concerns about patient alienation in light of an increasingly fragmented NHS.

This fragmentation is often a good thing. Increasing fragmentation of services allows for the signposting and outsourcing of patients to the most appropriate forms of care- whether that be social, psychological, physiological or clinical. It allows them to access specialist care early on and, if patients are directed towards the right health care professionals at the point of inquiry, this relieves burden on medical generalists such as GPs, practice nurses and other practice staff.

Moves towards social prescribing and greater collaboration works in tandem with the wider incentive of digitalising the NHS. Online GP providers are becoming more common, and the booking of consultations often takes place on the internet or through apps. We have access to more resources than ever, but we may have to navigate our way through an online maze to get there.

How is this all working in relation to the elderly – the demographic deemed to be the least technologically savvy and the most likely to be overwhelmed, confused or isolated by primary care due to the increasing digitisation and fragmentation of the NHS?

Is this assumption mere myth?

When it comes to internet consumption, we are right to assume that young people are the greatest users; however, the gaps in usage of different age groups are decreasing – apart from in the over 75s.

This trend is not necessarily reflected in the health care domain. The young, although spending swathes of time browsing the internet, are not the biggest users of online health information, and are not the most likely to book online appointments.

Surprisingly, perhaps, the greatest awareness of digital health care exists in 65-74 year olds. They are more likely to book appointments or order repeat prescriptions online. It is not true, then, that this demographic is being squeezed out of healthcare entirely by the digital era.

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We should not unduly patronise the elderly in relation to their ability to move nimbly around the internet; after all, the internet can be an excellent place to seek health information and support and to organise appointments for those with mobility issues. Creating more online services for these patients is a way of increasing access.

Age, although a factor, is probably not the most important when it comes to an increasingly digital NHS. For example, 33% of people with disabilities have never used the internet. Those with learning disabilities, dementia or sight impairment may be less aware, or less able, to use online services. The incidence of these increase with age but, of course, afflict all age groups.

Face-to-face still crucial

It is important to remember that digital advantages, although highly useful to some in the elderly demographic, also have the potential to alienate others – especially the over 75s. Professor Helen Stokes-Lampard, chair of the RCGP, highlights that, for the growing number of patients living with complex health needs who may not be tech-savvy, face-to-face GP consultations are key to managing their health. Thus, in a family practice, in-person communication must remain core.

“It’s essential that, as new technologies become more widespread, patients without smartphones, who prefer accessing their GP via more traditional means, are not left behind,” Dr Stokes-Lampard said.

The digital health services that you implement in your practice, therefore, should be designed to cater for those who may find it hardest to engage with them. This is a variation of the rule ‘walk at the pace of the slowest hiker’; if you manage to engage the least digitally skilled, most people will be able to navigate your website, the services you offer there, easily.

Offering free-Wi-Fi in your practice, and advertising your online presence in your waiting room, may increase the patient uptake of these services. Making sure all your online copy is put through the accessibility checker in Microsoft Word also ensures that those with learning disabilities won’t be so immediately excluded.

Ultimately, the fragmentation of NHS services by digital means will benefit some in a demographic and not others. The myth that elderly patients cannot, or will not, use online health services is one that needs debunking – but practice managers increasingly moving to digital should keep in mind the barriers to access this may present to patients.

The key to a happy, healthy practice, therefore, is diversity: diversity of employees, diversity of services, and diversity of access to those services.

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