Locked out: digitally excluded people's experiences of remote GP appointments

Healthwatch England wanted to speak to groups traditionally more likely to experience digital exclusion to understand why and how this can impact their healthcare experiences, especially during the pandemic. 86 patients and 26 members of staff took part. 

These groups included older people, people with disabilities, and people with limited English.  found that people can be digitally excluded for various reasons including digital skill level, affordability of technology, disabilities, or language barriers. Participants often mentioned that they weren’t interested in accessing healthcare remotely, even if they could.

The stories we heard about using GP services during the pandemic were mixed. Some people who traditionally experienced barriers to accessing care, like carers or people with mobility issues, found the shift to remote care beneficial. In general, people understood the benefits of remote and digital care and appreciated the need to shift to these methods during the pandemic rapidly. However, we found that services frequently overlooked individual support requirements, and digital health systems had little means of anticipating them.

Not knowing how to seek alternatives to remote booking systems or appointments meant some people became entirely reliant on their families for accessing healthcare, received poorer quality care or abandoned attempts to seek healthcare altogether. Those who experienced multiple barriers to accessing care found it even more difficult to seek alternatives independently. People experienced significant difficulties booking an appointment via e-consult or reception. This part of the booking process was by far the main point where people felt excluded and gave up trying to access care.

In particular, people with low digital literacy or language barriers struggled to use e-consult systems and sometimes felt discouraged from seeking an appointment in another way. People who tried to call their GP instead frequently complained of long waits on phone lines or difficulty getting an appointment at all.

We also interviewed staff at GP practices as part of this project. While staff wanted to retain the added efficiency of remote care where possible, they acknowledged that the total shift to remote methods had excluded some people from care, and a better balance between face-to-face and remote methods is needed.

 As we transition out of the pandemic, primary care needs to rebuild based on a hybrid system, doing everything possible to reduce barriers to accessing care remotely while giving people the agency to decide what kind of appointment is right for them. However, in the long-term, people – particularly those who are more vulnerable, like our research participants – need to be supported to develop their digital skills and facilitated to go online. Our analysis points to the need for a bold programme of investment in digital literacy and online access while emphasising the importance of maintaining face-to-face methods to ensure no one falls through the gap.

The report contains 5 recommendations.