Treadgold Bethan Mair, Winder Rachel, Atherton Helen, Bryce Carol, Campbell John, Marriott Christine, Newbould Jenny, Stockwell Stephanie, Pitchforth Emma
Research Fellow, Exeter Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter, UK.
Professor of Primary Care Research, Unit of Academic Primary Care, Warwick Medical School, Warwick, UK.
J Health Serv Res Policy. 2025 Jul;30(3):161-170. doi: 10.1177/13558196251316446. Epub 2025 Jan 30.
ObjectiveDigital services in primary care are becoming more common, yet access to and use of services can create inequities. Our aim was to explore the drivers, priorities, and evolving policy context influencing digital facilitation in primary care as reported by national, regional and local level stakeholders in England.MethodsWe conducted online semi-structured qualitative interviews with stakeholders, including those in NHS England organisations, local commissioners for health care, statutory and third sector organisations, those working within the research community, and digital platform providers. Interviews were analysed using a thematic approach.ResultsThe majority of stakeholders worked in national level roles, in commissioning or statutory and third sector organisations working in relation to digital inclusion and patient access. Demographic inequalities, poor usability of digital primary care services, and low digital skills were perceived to comprise some of the barriers facing patients in accessing and using digital primary care services. Demand pressures in general practice, inconsistent training opportunities in digital services for staff, and conflicting perceptions around who should be responsible in organising digital facilitation were reported as barriers in the organisation and provision of digital facilitation in primary care. Stakeholders shared future visions for digital primary care and recommended focusing on establishing the concept of digital facilitation and promoting the benefits in its adoption.ConclusionsPolicy that is specific to digital facilitation and not just to digital services is required to establish clear lines of responsibility, investment in staff time and training, and the development of digital services that work well for various groups of patients and practice staff. A multi-organisational working team involving decision-makers and those working on the ground in general practice is encouraged to establish principles for supporting patients and staff in accessing and using digital primary care services in the NHS in England.
目的
初级保健中的数字服务正变得越来越普遍，但服务的获取和使用可能会造成不平等。我们的目的是探讨影响英格兰国家、地区和地方层面利益相关者所报告的初级保健数字便利化的驱动因素、优先事项和不断演变的政策背景。
方法
我们对利益相关者进行了在线半结构化定性访谈，包括英格兰国民保健服务体系（NHS）组织、地方医疗保健专员、法定和第三部门组织、研究界工作人员以及数字平台提供商的人员。采用主题分析法对访谈进行分析。
结果
大多数利益相关者在国家层面任职，在与数字包容和患者获取相关的委托或法定及第三部门组织中工作。人口统计学不平等、数字初级保健服务的可用性差以及数字技能低被认为是患者在获取和使用数字初级保健服务时面临的一些障碍。据报告，全科医疗中的需求压力、工作人员数字服务培训机会不一致以及围绕谁应负责组织数字便利化存在相互冲突的看法，是初级保健中组织和提供数字便利化的障碍。利益相关者分享了数字初级保健的未来愿景，并建议专注于确立数字便利化的概念并推广其采用的好处。
结论
需要制定专门针对数字便利化而非仅针对数字服务的政策，以明确责任界限、投资员工时间和培训，并开发适用于各类患者和执业人员的数字服务。鼓励成立一个由决策者和全科医疗一线工作人员组成的多组织工作团队，以确立支持患者和工作人员获取和使用英格兰NHS数字初级保健服务的原则。
