1. Getting Started Checklist
Patient Online
Getting Started Checklist
Learn about Patient Online
Contents
Patient information
scheme
Team roles and training
Proxy access
Appointments Prescriptions
Planning for Patient Online
Monitoring Patient Online
Record access
Promoting
Patient Online
Signing-up patients

2. Planning Patient Online
Introduction
You can use this document as a guide and a checklist for the steps you will need to take to getting started with providing and offering Patient Online. If you have already started, the checklist may be useful to help you review your systems and see if any of the important steps are missing. Each step is covered on a page of this document.
Steps to get started with Patient Online
Learn about Patient Online
Establish practice team roles
Carry out a training needs assessment and provide training based on guidance from the RCGP, GP suppliers and NHS England
Design a system to sign on new applicants for Patient Online
Design appointment and prescription systems that complement the current practice systems
Design the record access system including clinical assurance of the records that the patient will see and minimises the risks for vulnerable patients
Find and prepare promotional materials to encourage patients to take up the services
Find and prepare accessible information about Patient Online.
Design a proxy access system for family members and carers to have access to Patient Online on behalf of the patient
Monitor your Patient Online service that the practice is providing for uptake and quality assurance
Put in place solutions that help over come the barriers that may reduce patient uptake of online services, such as a lack of awareness of Patient Online, digital exclusion and poor health literacy.
Create a suite of standard forms, protocols and policies that describe how the practice Patient Online service works
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You can initial and date the box on each page as you complete that section of preparation
Where does this fit in
There are other guidance documents in the Toolkit that explain getting started with Patient Online in more depth:
Getting Started with Appointments and Prescriptions
Getting Started with Record Access
Patient Information about Patient Online
Identity Verification
Proxy Access
Children and Young People
Coercion
Information Governance

3. Learn about Patient Online
Find the information you need to know how to implement Patient Online
Identify a lead GP and senior non-clinical staff member to learn about Patient Online and take responsibility for coordinating the planning, design, implement and management of Patient Online.
This checklist is one of the suite of guidance documents, templates and elearning modules for practices in the Patient Online Toolkit that can help you implement Patient Online.
GP system suppliers and other suppliers of Patient Online Apps also provide guidance for practices and patients on how to use their systems.
NHS England provides guidance and resources to support Patient Online including patient information leaflets and promotional materials that you can order on their website.
There are resources for patients on the NHS website.
English practices have a contractual requirement to offer and promote Patient Online. The latest GMS/PMS Contract Regulations are available on the NHS England website.
Carry out a staff training needs analysis and provide training.
Find and prepare accessible information about using online services for your patients. For more information see the Patient Information guidance in the Toolkit.
Find and prepare promotional materials to encourage patients to take up the services.
Plan for possible barriers to patient uptake of online services, such as digital exclusion. There are 5,000 local learning centres or you can direct patients to LearnMyWay.
Patient Online System Suppliers
EMIS
TPP
InPS
Microtest
Evergreen Life
Wiggly Amps
iPlato
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4. Team roles and training
Ensure that team members understand their roles
Allocate roles to practice team members:
Carry out a staff training needs assessment that aligns with the allocation of staff roles
Plan training for practice staff and make guidance and resources available.
The practice training should be based on practice policies and protocols
Staff members should be prepared for rapid uptake of the service and plan for increased demand for registrations and queries from patients.
The training scheme curriculum
The scheme should ensure that team members understand their role(s) in Patient Online, including:
how the practice and computer systems work;
how to inform patients about using online services and help them register;
how to verify patient identities;
how to support patients with sensory, intellectual or other needs such as IT literacy;
how to identify risk of coercion or safeguarding needs;
how to manage requests for proxy access;
how to address patient concerns;
how to check records and redact data as necessary before access is switched on;
indications for refusing or curtailing record access;
how to monitor the system to identify and manage risks.
Practice team roles
Identity verification lead and team
New applicant registration lead and team
Clinical assurance lead and team
Proxy access lead and team
System design lead for appointments
System design lead for prescriptions
Information governance lead
Safeguarding lead
Record data quality lead
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5. Appointment and prescriptions
Design the online appointment system
Make registration forms available, on request or printed for every appointment
Switch on both appointments and prescriptions for every patient that asks for either service.
Allocate appointments that can be booked online for GPs, nurses, pharmacists or other practice team members
Allocate the number, length and type of appointment slots to be made available
Open online appointments at the same time as appointments bookable by telephone or any other route
Agree whether to limit the number of future appointments booked online that an individual may have at any one time
If you have branch surgeries, decide which surgeries will patients be able to book appointments online for
Agree when you will allow parents and carers have proxy access and when you will provide proxy access on behalf of children
Design the online prescription service
To complement rather than replace current prescription request systems and reduce practice workload
Highlight in practice policy that repeat prescriptions that the patient no longer needss are removed from the record as soon as possible
Continue to monitor concordance
Ensure that the online system complements repeat dispensing and use of the electronic prescribing service
Agree whether to allow patients to use the online service to ask for a prescription that is not on their repeat prescription list
Agree how to manage messages and online requests for acute prescriptions
Toolkit References
Online Appointments and Prescription Service, getting started
Proxy Access
Children and Young People
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6. Record access Toolkit References
Design the system for managing new requests for record access
Allocate roles to team members, especially identity verification, clinical assurance and proxy access decisions
Agree what level of record access you will offer: detailed coded record or more; prospective or retrospective access for clinical correspondence and free text if offered; configured to suit the individual patient or a single standard offer for everyone
Agree a standard practice approach to data quality, in particular to managing potentially harmful data and confidential third party data
Agree criteria for refusing or restricting record access; the GP may wish to review the record and discuss the content with the patient before authorising access
Agree how many patients the practice can register each month, considering the number of requests and the time taken to check each record
Develop policies for data quality; managing harmful or third party information; abnormal test results, errors in the record; managing patient complaints about the record; access for parents, guardians, carers and proxies nominated by the patient; patients with mental health problems; coercion and safeguarding and refusing access for individual patients access. All policies should be reviewed at least annually and updated as necessary.
Toolkit References
Online Record Access, getting started
New Applications for Record Access
Proxy Access
Children and Young People
Coercion
Information Governance
Safe Patient Online Record Access
Data Quality
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7. Signing-up new patients
Every member of the practice team should know how to respond if someone asks for access to the practice online services. They should know who will handle new applications if they are not trained to manage it themselves
Practice staff should be aware of safeguarding risks related to Patient Online and be vigilant for indications that an applicant may be vulnerable to being coerced into sharing their online access unwillingly
There should be clear advice about the practice policy on checking records for sensitive data before record access is switched on. Patients will want to know how long it is likely to take to switch on their access.
Patients must attend in person for their identity can be verified and confirm how they would like to receive login credentials (normally by post or secure ). The credentials must only be sent to the patient themselves.
If the patient is to be given login credentials by hand, identity verification must be carried out when the credentials are given to the patient.
Patients must complete all parts of the registration form. You may want to use the RCGP registration form template.
Ensure patients who are new to your online services or record access are fully informed about how to use the services, how to keep their access secure and how to contact the practice if they encounter problems securely. Consider offering all patients verbal and accessible written information.
If record access is refused, explain your reason to the patient and record the reason in the patient’s notes.
Toolkit References
Online Appointments and Prescription Service, getting started
Online Record Access, getting started
New Applications for Record Access
Patient Information
Registration Form Template
Identity Verification
Information Governance
Safe Patient Online Record Access
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8. Promoting Patient Online
Decide on the messages to use to promote online services, the headlines are in the boxes opposite.
Plan how you are going to communicate the message to patients: through leaflets, posters, waiting room information screens. new registration information packs, the practice website or local agencies such as community pharmacies, libraries, post offices and voluntary agencies. Consider involving the practice Patient Participation Group (PPG
Find sources of promotional materials. Your GP system supplier or other suppliers of online patient access may offer them and NHS England has a suite of promotional materials and patient leaflets, which you can order online.
Encourage reception staff to ask every patient if they use the internet, if are interested in using Patient Online (at least face to face, and at quiet times on the telephone), if they would use an app on their smartphone or tablet.
Consider recommending online access at point of care, e.g. when taking blood tests, at a long term condition clinic or medication review
Introduce a “floor walker” during surgeries to encourage waiting patients to register. Members of the PPG may do this.
Consider carrying out targeted campaigns for particular groups of patients, such as those attending long term condition clinics, uses of repeat prescriptions
Cater for special patient needs for large print notices, braille and easy-to-read materials may need to be provided.
There is information about accessible information, including easy read patient leaflets on the NHS England website
Appointments and Prescriptions
Consider distributing registration forms when when new patients register with the practice and when patients attend for appointments.
Consider recommending appointments and prescriptions when patients apply for just one.
Consider inviting your patient participation group to help to design the system.
Records Access
Patients can see what is in their health record, saving calls to the practice about results and hospital letters
It can help them improve their health literacy
It can help them self-manage their health, including specific long term conditions
It can help family and carers support them through proxy access
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9. Patient Information Scheme
Appointments and Prescriptions
Explain which team members offer appointments online.
Emphasise the importance of cancelling appointments when they are no longer needed.
Consider inviting your patient participation group to help to design the system.
It may be necessary to explain the difference between online repeat prescription services for patients and Electronic Prescription Service. Patients must sign up for each service separately.
Design a patient information scheme using accessible materials including written documents, easy ready documents and pages on the practice website.
Decide on the information that you want patients who use your online services to have. Refer to the Patient Information checklist for guidance on information that practices have found that it is useful for patients to have.
Patients benefit from understanding
How to sign up for Practice Online
How to use online services successfully and safely
How to keep their online access secure and avoid coercion to share their access with a third person.
When to delegate online access to a third person or proxy
How and when to contact the practice or seek help with their online access
Check patient information leaflets provided by your GP system supplier NHS England and NHS Choices to see if they meet your needs.
NHS England has produced guides to help staff support people with access needs.
The Good Things Foundation has online courses for patients about Patient Online.
Records Access
How to keep their record access secure
What to do if they see information that they disagree with or find upsetting, or that they cannot understand or is about a third party
What to do if they want to share their record access with another person
How to improve their health literacy
How record access can help them to manage their own health, including specific long term conditions
Toolkit Reference
Patient Information
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10. Proxy Access Proxy Access for Organisations Toolkit Reference
Agree the circumstances under which the practice will allow proxy access to someone acting on behalf of the patient. Consider patients with and without capacity to make an informed choice.
Decide what level of access proxies may be allowed. some practices choose a standard level of access for all patients and proxies. Others decide to tailor the level of access available to proxies to the needs and wishes of the patient. This may be at the level of
Appointment and prescription service
Detailed coded record access
Full medical record access
Decide on the information and advice that you want patients to have when they are thinking about giving someone proxy access.
Decide whether to give proxy access to organisations such as nursing homes..
The patient should complete a consent form for proxy access. Ensure consent is valid and verify the identity of the patient consenting and the proxy receiving login details. You may want to use the RCGP Proxy Access Consent Form template..
Proxy Access for Organisations
It is safer to restrict proxy access for direct care by health professionals working in an organisation such as a nursing home to named individuals. If an individual with their own login credentials leaves their organisation, it is simple to switch off their access without interfering with others’ proxy access. Proxy access for direct care should be covered by a written data sharing agreement.
Toolkit Reference
Patient Information
Proxy Access Consent Form template
Proxy Access
Proxy Access on behalf of Children and Young People
Coercion
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11. Monitoring Patient Online
You can monitor the practice uptake and online activity and compare you numbers with other practices at the NHS Digital GP Data Hub which should offer monthly updates. Look for Patient Online Management Information (POMI)
Consider inviting volunteers to pilot Patient Online and provide feedback on how they found it.
The Patient Partnership Group may help to pilot Patient Online.
Encourage patients and practice staff to report any concerns or problems that they have with Patient Online.
Consider keeping a report log and update it with actions taken. Regularly review the log to look for trends.
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