How do you put a digital service on paper?

Having a paper registration form will continue to be an important method of registration for some groups of people and will help to safeguard against digital exclusion, which is a recognised barrier to accessing health services.

GP surgeries already have their own established paper processes in place, long before the online service was even conceived.  So why do we need to create a new paper form?

We know that one of the most common problems is variation in the process when registering with a GP surgery. Many GP surgeries have created their own forms to supplement the national GMS1 form. We want the new form to mirror the online service and include all the information needed by a practice to register a patient in just one form. By reducing duplication, we will reduce the likelihood of errors.

By improving the paper patient registration form, we hope to lower the barrier for patients accessing healthcare. It also allows us to ‘provide a joined-up experience across all channels’, which is a key service standard to meet when designing government services.      

We can see that in the practices that are enrolled in the Register with a GP surgery service, only about half of patient registrations are done online. This suggests that the remainder are still done on paper – so it’s still a really important channel to consider.

We wanted to take what we learned when designing the online service and apply it to creating the new paper form.

For our first design, we followed the order of questions listed in the online service as closely as possible, while working within the constraints of paper, where space is limited and less flexible. We had a requirement for the form to be printable in colour, or black and white, and followed best practice for accessibility and design for print.

After designing this version and making small iterations, we wanted to find out how the paper form worked in real life, so we decided to run a pilot with GP surgeries.

We took a phased approach to our pilot, increasing the number of GP surgeries incrementally. Each phase had qualitative success measures before moving to the next phase, which increased the number of GP surgeries using the paper form each time.

The first phase included 3 GP surgeries, who tested the form for a couple of weeks. During this time, the GP surgeries told us of any problems or if things were missing on the form. We gathered feedback from these surgeries over a video interview to make sure we were confident in sharing the paper form with an increased number of GP surgeries.

As phase 1 was nearing an end, we shortlisted 100 further GP surgeries to invite to the next phase, considering a range of factors including geographical location, patient list size, patient demographics, domains of deprivation and clinical system used. This ensured the second group was representative of the different GP surgery demographics in England, to make sure we were testing and learning as much as we could from the pilot.

From our shortlist, 32 GP surgeries volunteered to participate in the next phase. These surgeries received instructions to print the form and to give this to people who preferred to register using paper. Surgeries were asked to complete a survey about how this form compared to their previous process, and if there was anything that needed to be changed. Many took part in follow-up interviews so they could share their insights in more depth.

Interestingly, in phase 2, we discovered some questions were missing from our overall service – for example, a question about the Summary Care Record. This prompted our team to write and design new questions, exploring how they work on both paper and digital. As a result, ‘Do you want important information from your GP record to be available to other health and care professionals?’ was added to our set of questions.

Working collaboratively allowed us to make sure they were included for the next version and phase of the pilot.

During phase 2 we also worked on improving the order of the questions, to make them flow better for both patients and GP surgeries. This was informed by a wider piece of research that was being carried out for the whole service to think about the mental models of people when completing forms and what questions they group together. When we design with a person’s mental model in mind, it allows people to interact as easily as possible as they can predict what’s next or what to expect.

During this phase of our pilot, we doubled the number of GP surgeries taking part. After 11 weeks of GP surgeries testing the form, we received positive feedback from GP surgery staff and their patients.

Both the digital service and paper form collects all the information required for both registering a patient and allowing the GP surgeries to understand more about their patients and their health needs. We were told having this all on one form was really helpful and saved the practice time contacting the patient for more information later on.

We were also told that the flow of information on the form made it easier for GP surgeries to input information into their clinical systems, leaving less room for human error.

Patients also provided feedback on the new form, saying it was easy to use and could be completed with someone they trust so they could support one another.

We’re excited to move into the next phase of rollout where the paper registration form is now available to all GP surgeries using our digital service.

The patient registration form is available to download from the self-enrolment journey within NHS Profile Manager, which is where GP surgeries sign up to our service.

When patients fill in a registration form, whether it is the online or new look paper version, they will also get confirmation of their successful registration, thanks to another pilot being run by the team to test the new Notify a patient service.

The Register with a GP surgery service will continue to gather feedback from GP surgeries and people who need to register with a GP surgery, through feedback forms and meetings with GP practices and charities, so we can continue to learn and iterate our service to make sure it is meeting the needs of everybody.