Review into GP Websites suggests things are Good, but could be Better

In the countdown to the e-government's targets for 2005, there have been several high profile periodic reports on the failure to achieve e-government compliance by various branches of the NHS. If the press is to be believed, and with just a little over a year to go, progress on building an online resource for patients has been poor, very expensive and non-linear.

On the contrary, the i-Metriks review shows that progress is being made in several important areas. It also suggests that although GP practices are not as good as they chould be, it would only take a small amount of effort to bring about a significant improvement for the GP community and the potential to reduce costs for practice and practices.

The findings are the result of an ongoing review of Web and intranet design and implementation in the UK, which focuses on usability and value generation (ie can the investment generate the necessary return to justify it?). Part of this includes a review of the usability of public service websites ranging from national government sites through to general practitioner's websites.

The key questions that this review raises are the following:

· Can efficient usability practices on GP websites be utilised to generate cost savings in the NHS at the local level?
· To what degree do GP sites comply with regulatory requirements with reference to design, usability and maintenance?
· How can improvement to the level of patient service and care be derived as a result (including functions such as access to practice information, ordering repeat prescriptions, etc)?

From our review of GP sites our conclusion is that it is a 'good news-bad news' story. The good news is that GP sites tend to be small and therefore are easy and cheap to implement and to maintain. Because of this, the sites generally score as well as local government sites which are implemented with far greater resources: they have simple to understand user interfaces.

However, it seems that while many GPs implemented websites in the late 1990s, which would have been quite good by the standards of the time, GP sites have generally not kept up with changes in design, functionality and user expectations. By not maintaining their sites they make it more difficult for their community to take advantage of the site, they also run the possibility of falling foul of the Disability Discrimination Act (DDA) as it will apply when it comes into full effect in October 2004.

The simplicity of the sites makes them easy to use for most able users, however, disabled users are not well catered for. The typical issues are simple to remedy, such as failing to attach descriptions to pictures and illustrations, which would be read aloud to users with visual impairment. Similar issues relate to menu bars which are implemented using pictures for buttons which again can not be read to disabled users.

GPs are also missing an opportunity to use their websites to reduce costs and create more resources for their patients online. While many members of their community will not have access to web sites, many do and want to utilise them more effectively. If they are encouraged to use the website frequently, administration costs can be reduced through handling enquiries and simple processes on-line (for example ordering repeat prescriptions) thus reducing the amount of administration around handling forms and answering phones.

Importantly we found many GP sites also have a lot of positive attributes that should be retained.

Many GPs keep their sites up to date, such as describing new facilities available, opening hours and so forth. The sites are designed as very simple sites and this is beneficial for almost all users. Finally, some GPs consider the linguistic needs of their users and offer data and services in languages other than English. This ranges from webpages in Welsh in Wales to Bengali in East London.

When the Disability Discrimination Act is enforced, it will result in many GPs re-evaluating their web sites to ensure compliance. In doing so many will consider re-design and re-implementing their websites. This solution may not be necessary, as modifications rather than replacement will frequently be sufficient. Specifically, GPs who do not wish to re-implement their sites should consider having a in-depth accessibility audit conducted to identify where they may fall short of the act, and simply have pages changed accordingly.

The broader question remains; will GPs take advantage of the opportunity to offer a greater degree of choice when it comes to providing patient services and reducing administrative costs through allowing patients to self serve. The improvement to the level of patient care that can be derived as a result, with functions such as access to practice information and ordering repeat prescriptions will be twofold: reduction of costs and better levels of patient care.

Michael McGrath
Managing Partner
i-Metriks Partnership

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