benefits of using nhs choices in conjunction with gp consultations

Customer Insight Public information

The Benefits of using NHS Choices in Conjunction with GP

Appointments

November 2012


Contents

• Sample and methodology

• What is the impact of NHSC on GP visits?

• How is NHSC used by the public in relation to GP visits?

• How is NHSC used before and after a GP visit?

• What other health information do NHSC users use?

• Executive summary

• Conclusions & Recommendations


Sample and Methodology

Type of survey Online pop-up survey on selected pages of the NHSC website

Methodology Online survey

Fieldwork dates August 2012

Sample Total sample completes n=2735

Sample distribution General public – self selecting sample of site visiting for themselves

Previous research

conducted

2010: The Imperial College (commissioned by NHSC). Nelson. P,

Murray. J, Saleem Khan. Muhammad. NHSC Primary Care

Consultation Final Report, Imperial

2011 survey: which in part replicated the study conducted in 2010

Other information Analysis has been undertaken primarily on those who use NHSC

alongside a GP visit = 1356

Sample & Methodology

Customer Insight Public information 4 Base all respondents n=2735

Web pages the pop up survey was placed on Respondents who came

through to the survey from each

web page

Number of

respondents

Per cent (%)

Conditions – Depression (Introduction) 690 37

Conditions – Menopause 273 15

Behind the headlines 245 13

Conditions – Type 2 Diabetes 62 3

Search results 58 3

NHSC Homepage 52 3

Live well – hub 48 3

Service directory 40 2

Conditions – Urinary tract infection 33 2

Change for life 30 2

* A breakdown of web pages on which 1% of the respondents completed

the survey on is available on request.

Main website pages recruiting respondents.


What is the impact of NHSC

on GP visits?

Customer Insight Public information 6

Conclusions

1. NHSC has significantly reduced the frequency of GP visits

since 2011.

4. NHSC is viewed as a valuable source of health information,

particularly when used in conjunction with a GP visit.

5. NHSC and NHS Direct are the main health information sites

utilised amongst current NHSC users.

3. Deciding whether to visit the GP is a key driver for NHSC

usage amongst respondents who use NHSC ‘before’ a GP visit.

2. There is a significantly greater impact on reducing GP visits

when NHSC is used before and during a GP visit.

Key Takeaways

Almost half of the NHSC users use the site in conjunction with

a GP Visit. Amongst these respondents….


Half of all respondents surveyed reported to use NHSC

alongside a GP visit. Over two thirds of users utilise NHSC BEFORE a GP visit &

half utilise NHSC AFTER a GP visit.

All surveyed 100%

(n=2735)

YES 49%

N=1356 NO 44%

N=1194

Before appointment (70%)

N=944

After appointment (52%)

N=707

During appointment (6%)

N=84

Don’t know 7%

N=186

Those using NHSC for GP visit

Female = 80%

Male = 20%

2%

• Respondents were able to

choose more than one occasion

• Despite an significant increase

since 2011, the propensity for

GPs to use NHS Choices during

a consultation remains low.

3%

Significant change since 2011

Have you ever used information from NHS Choices before, during or after a visit to your GP? Please tell us in what

ways you use NHS Choices when considering a visit to your GP?


Four fifths of NHSC users are female & aged between 25-64 yrs.

Two fifths of users have children aged between 0-17 yrs.

Gender

Female

80%

Male

20%

Age

1%

4%

7%

21%

19%

21%

16%

8%

2%

Under 16

16-19

20-24

25-34

35-44

45-54

55-64

65-74

75+

Gender?, How old are you?, Do you have children under the age of 18 living with you?

Profile of respondents who use NHSC in conjunction with a GP visit.

Children

11%14%

11%

31%

41%

Child/children

aged 0-4

Child/children

aged 5-12

Child/children

aged 13-17

None under 18

living with me

No children

36%

Base: All respondents who have used NHS choices in conjunction with a GP visit 2012 = 1355


How does NHS Choices affect the number of visits you make to the GP / Practice Nurse?

25%

62%

6% 6%

27%

69%

4%

Decreases the number of

visits I make

Makes no difference Increase the number of

visits I make

Don’t know

2012 2011

Direct questioning does not reveal a significant decrease in GP

visits since 2011.

Base: Used NHSC in conjunction with a GP visit: 2012 = 1355, 2011 = 925

Only 6% of first time users

reported NHSC makes no

difference to the number

of GP visits in 2012

Impact of NHSC on GP visit.


34%

21%

25%

14%

3%

3%

Every 4-6 months

Less than once a

year

Every 2-3 months

Monthly

At least weekly

Don’t know

10

How frequently do you visit your GP for yourself or a family member?

Frequency of GP visits.

Every 6 months 22%

Monthly 17%

Every 3 months 27%

Less than once a

year

21%

At least weekly 5%

Don’t know 7%

2011

Base: All respondents who have used NHS choices in conjunction with a GP visit 2011= 925, 2012 = 1355

2%

Note: 2011 and 2012

data is not truly

comparable

Indirect questioning demonstrates NHSC users have significantly

decreased weekly GP visits since 2011.

Represents the

majority of patients

with a long standing

illness.



How frequently do you visit your GP for yourself or a family member?

Base: All respondents who have used NHS choices in conjunction with a GP visit 2011= 925, 2012 = 1355

The average number of GP visits has significantly decreased

since 2011.


Average visits per year

2011 6.39

2012

5.59

1 visit


How does NHS Choices affect the number of visits you make to the GP / Practice Nurse?

28%

31%

23%

33%

26%

21%

Before During After

2012 decrease in visit 2011 decrease in visits

Those respondents who use NHS Choices BEFORE & DURING

a GP visit show far greater propensity to decrease GP visits.

5%

5%

Base: Used NHSC in conjunction with a GP visit: 2012 = 1355, 2011 = 925


Impact of NHSC on GP visit.


14 29

25

26

29

13

12

17

8

6

18

20 30

33 7

Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

13

NHSC has a significantly better impact on helping users manage

their own symptoms & reducing the need for a GP visit BEFORE and

DURING a GP visit.

To what extent do you agree/disagree with the following statement: I am able to manage my own symptoms instead

of visiting my GP.

Base: Used NHSC BEFORE a GP visit = 994, DURING = 84, AFTER = 707

I am able to manage my own symptoms instead of visiting my GP.

AFTER

BEFORE

DURING

51%

50%

43%

% Agree


• Additional site visits using most available data leading up to and during the survey

A total of 1.8 million users have decreased GP visits.

Source: Web trends

6 Million

1.4 Million

2010 2011

Swine flu lead

site activity in

2010.

1.8 Million

2012

12% of all

NHSC users


How is NHS Choices

utilised by the public?


72%

9%

8%

8%

2%

For myself

For my child

For an adult family member

For both professional (health)

and personal reasons

For both professional (non

health) and personal reasons

16

Three quarters of NHSC users visit NHS choices for themselves.

There has been a significant increase in NHSC usage for family

members.

Which of the following best describes the reason why you generally visit NHS choices?

Reasons why NHS Choices is visited.

Base: All respondents who have used NHS choices in conjunction with a GP visit 2012 = 1355

10%

5%

9%


Data suggests NHSC

is a trusted and a

reliable source of

information amongst

users.


75%

57%

54%

51%

46%

37%

32%

19%

9%

4%

To find information on my symptoms / conditions

To learn about my treatment options

To help me decide if I'm going to visit my GP

To help understand information I was given during an

appointment

To look up information about medicines / side effects

To help me ask specific questions during a GP/nurse

appointment

To help me be more prepared before I see the GP /

Practice Nurse

To find information about my GP practice e.g. opening

hourse, contact details etc

Pregnancy info

Other

17

Becoming informed on symptoms/conditions & treatments,

deciding whether to visit the GP top the list of reasons users engage

with NHS Choices alongside a GP visit.

Have you used NHS Choices for any of the following reasons when considering to make a visit to your GP?

Base: Those who have used NHSC with a GP visit ; 2012 = 1355, 2011 = 925

Preparing for GP appointments could

potentially impact on the number &

length of GP visits, potentially

resulting in long term cost savings.


5%

4%

2%

Reasons for NHSC usage alongside GP visits.

An increase in health &

treatment knowledge can

empower users to

manage their own

symptoms and to make

shared decisions with

their GP.


HOW IS NHSC

USED?

18

Users use NHSC to determine whether a GP visit is required: quotes

Base: All respondents who answered question n=75

In what ways have you used NHS Choices in relation to your GP visit?

“To check symptoms of an

illness for my son before

phoning GP for an

appointment to ensure I was

not wasting their time & his

symptoms were serious

enough to warrant an

appointment ”

“To find information on the GPs

diagnosis and treatment as i often come

out of the consultation thinking i should

have asked more questions but

do not like to take up more of the doctors

time so this web site helps and if i have

issues i can always ring the doctor”

“To consider my symptoms to find out

whether a visit to the doctor is necessary

and what he might diagnose so that I am

prepared to ask any questions”

“I will research symptoms online first and then

decide whether I need to see my GP”

“Using the symptom checker to see if the

symptoms I am experiencing require a GP

visit”

“To find out more information on

diagnosis, easier to browse at my leisure

and digest information.”

“Website narrowed down the cause and at times I

could maybe change diet or something like that,

meaning there was no need to visit my GP...”


How NHSC is utilised

before and after a GP visit?


13%

25%

19%

20%

14%

6%

1%

3%

14%

20%

17%

22%

18%

9%

2%

1%Under 16

16-24

25-34

35-44

45-54

55-64

65-74

75+

Before After

Base Those who have used NHSC BEFORE a GP visit = 360

Profile of users who use NHS Choices BEFORE + AFTER a visit

to their GP.

AGE Gender

81%

19%

80%

19%

Female

Male

• Women appear more

proactive seekers of health

information before & after

visiting a GP

• Younger users are more

likely to demonstrate

health seeking behaviour

before a GP visit and 45-64

year olds ‘after’ a GP visit

Base: Used NHSC AFTER a GP visit = 199


77%

68%

58%

47%

44%

44%

39%

23%

12%

3%

80%

68%

55%

50%

47%

46%

34%

22%

13%

5%





appointment



appointment


Practice Nurse


hours, contact details etc

Pregnancy info

Other

2012 2011

21

Checking for symptoms/conditions & deciding whether to visit

the GP remains the main drivers to use NHS Choices BEFORE a GP

visit.

Have you used NHS Choices for any of the following reasons when considering a visit to your GP?

Base: Used NHSC before a GP visit; 2012 = 944, 2011 = 678

5%


Reasons for NHSC usage BEFORE a GP visit.

Preparing for GP appointments could

potentially impact on the number &

length of GP visits, potentially

resulting in long term cost savings.

An increase in health &

treatment knowledge can

empower users to

manage their own

symptoms and reduce

GP visits/ length of visits

& make shared decisions

with their GP.


79%

71%

65%

56%

46%

37%

32%

18%

9%

4%

81%

65%

59%

54%

49%

43%

31%

20%

11%

4%



appointment





appointment


Practice Nurse



Pregnancy info

Other

2012 2011

22

Checking for symptoms/conditions & understanding information

given during an appointment are the main drivers to use NHS Choices

AFTER a GP visit.

Have you used NHS Choices for any of the following reasons when considering a visit to your GP? Base: Used NHSC after a GP visit ; 2012 = 707, 2011 = 507

6%

6%

6%


Reasons for NHSC usage AFTER a GP visit.


NHSC has a significantly better impact on health & treatment knowledge

When used BEFORE & AFTER an appointment. NHSC has a significantly better

impact on reducing the need for a GP visit BEFORE and DURING a GP visit.

I know more

about my health

Thinking about when using NHS Choices for your appointment, please indicate how much you agree or disagree with

the following statements.

% Agree

I am more

confident to ask

questions

I am more

confident to

express my point

of view

AFTER

BEFORE

39 46

9

10

8

3

1

2

8

2

36

38 39

45 4


DURING

81 %

77 %

85 %

78%

70%

82%

Base: Used NHSC BEFORE a GP visit = 994, DURING = 84, AFTER = 707

I know more

about my

treatment

options 36 46

12

17

12

2

4

2

7

2

32

31 39

46 4

AFTER

BEFORE

DURING

27 44

17

14

19

5

6

4

4

3

31

29 44

40 4

AFTER

BEFORE

DURING

71%

73%

71%

27 44

17

14

19

5

6

4

4

3

31

29 44

40 4

AFTER

BEFORE

DURING

64%

66%

62%

14 29

25

26

29

13

12

17

8

6

18

20 30

33 7I am able to

manage my own

symptoms

instead of

visiting my GP

AFTER

BEFORE

DURING

51%

50%

43%

= significant difference between 2012 sub-segments


How valuable is NHSC to

the public?


Vast majority of users, including first time users, perceive NHSC

information to be valuable in supporting their healthcare needs.

How valuable is NHS Choices information in supporting your healthcare needs?

Before

During

After

8% 1%46% 45% 0%

Very valuable Valuable Unsure of value Not very valuable Not at all valuable

7% 1%48% 44% 0%

4%0%54% 43% 0%

8% 1%47% 44% 0%

Overall

No significant change since 2011

91 %

92 %

97 %

91 %

%

Agree

6% 2%43% 47% 1%First time users 90 %

Base Used NHSC in conjunction with a GP visit = 1355


26 1516 30 7

24 624 39 3

18 528 42 3

26

80% of users agree they are more knowledgeable & confident

about their health and treatment options. Two fifths agree NHSC

enables self management of symptoms and GP visits are not required.

I know more

about my health (condition/illness)

When using NHS Choices for your appointment, please indicate how much you agree or disagree with....?

I know more

about my

treatment

options

%

Agree

I am more

confident to ask

questions

I am more

confident to

express my point

of view

Base: used NHSC in conjunction with a GP visit = 1355

12 332 46 3

81%

78%

70%

63%

I am able to

manage my own

symptoms

instead of

visiting my GP

9 335 46 3


43%

New question

4%


74%

45%

61%

60%

53%

41%

31%

17%

5%

4%

74%

62%

53%

44%

39%

34%

32%

21%

13%

3%





appointment



appointment


Practice Nurse



Pregnancy info

Other

Long term disease

Short term disease

27

A significantly greater proportion of users with long term

conditions use NHSC to learn about treatment options and to look up

information about medicines/side effects.

Have you used NHS Choices for any of the following reasons when considering a visit to your GP?

Base: Long term disease = 581, No long term disease = 721

Reasons for NHSC usage amongst users with a long term condition.

8%

16%

14%

7%

17%

8%


31

22

16

15 5

13

19 32

27 8

24

24

7

4 3

25

23 40

38 3

16

20

6

4 3

28

29 40

43 3

28

Little difference in NHSC outcome between users with long term and

short term conditions.

I know more

about my health (condition/illness)

When using NHS Choices for your appointment, please indicate how much you agree or disagree with....?

I know more

about my

treatment

options

%

Agree

I am more

confident to ask

questions

I am more

confident to

express my point

of view

13

11

3

2 3

33

32 46

46 3

82%

79%

71%

63%

I am able to

manage my own

symptoms

instead of

visiting my GP

10

7

3

3 3

36

35 47

46 3


40%

Base: Long term disease = 581, No long term disease = 721

82%

78%

69%

63%

51%

= Users with a long term condition

11%


Significantly higher levels of satisfaction with NHSC when used in

conjunction with a GP visit – higher than general site satisfaction.

12%

8% 8%

2%2%1%

35% 34%

37%

50%

8%4%

Satisfaction Survey Dec 2012Who use NHS Choices with GP visit (anytime)

Very Satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied Don't know / NA

Low satisfaction

How would you rate your overall satisfaction with the information available on the NHS Choices website to help

you with your appointments?

Base: Used NHSC with a GP visit 2012 = 1355 / 2735

High satisfaction

71% Agree

Source: Quarterly satisfaction survey 2011

Base: 2452

85% Agree


Satisfaction levels with NHSC.


Base respondents n=1203

Reason driving satisfaction Per cent (%)

Base: 1084

Accuracy and reliability 33

Clear and understandable 22

Finding information 20

Ease of use 15

Amount of information 8

Accuracy & reliability, clarity of information and ease of

finding information are the key reasons driving

satisfaction amongst NHSC users.

Reason driving dissatisfaction Per cent (%)

Base:119

Finding information 33

Accuracy and reliability 25

Technical issues – broken links 21

Amount of information 12


Base: All respondents who answered question n=75

“It is useful to go to a trustworthy site to get

facts so I can think about the matter with

good information”

Half of your links are broken I am a

student trying to find some work

experience/advice in therapy to

develop a career and I am just going

around in circles!”

“NHSC gave me the facts in simple terms I

can understand. The recommendations and

advice is clear and warnings are

appropriate. ”

“It sends me to a broken link on NHS

choices, where it seems surprisingly

hard to look up hip pain specifically

without getting suggestions for all the

other pains i might have instead.”

“Concise, user friendly, easy to understand

information which has helped me to focus on

which symptoms to discuss with my GP and to

ask appropriate questions about those

symptoms and about treatment”

Clear and understandable/finding info

“Clear concise information, easy A-Z index”

“Very easy to find the information

you need and to determine whether

a GP visit is necessary if you are

unsure”

So that we can help improve our site experience, please can you say why you

were satisfied or dissatisfied with the information available on NHS Choices in helping you with your GP appointment?

At times the site is not available, this is

very frustrating when looking for

information”

“Make website easier to read and

understand it takes me an hour to

find what I want.”

SATISFACTION

WITH NHSC

NHSC satisfaction/dissatisfaction quotes


What other health

information sites do NHS

users utilise?


49%

41%

18%

16%

15%

13%

13%

NHS

Choices

NHS Direct

BBC

Health

Wikipedia

Facebook

Boots

WebMD

Netdoctor

Utilisation of NHSC and other alternative health information sites

has significantly decreased. Supports users have increased their health

knowledge.

Do you use any other internet sites when thinking about your health or visiting your GP practice?

20% of respondents

use NHS Choices in

isolation

11%

10%

7%

7%

7%

7%

6%

6%

6%

5%

5%

5%

5%

31%

Patient UK

Direct Gov

British Heart Foundation

BUPA

Arthritis Research UK

Cancer Research UK

Diabetes UK

Yahoo Answers

Mind

Asthma UK

Macmillan Cancer Support

Thyroid UK

Other

None


Base: All respondents who use NHS Choices in conjunction with visit 2012 N=1355, 2011 N = 925

3%

4%

8%

7%

2%

3%

2%

2%

2%

5%

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GPs & Practice nurse tend to refer a significant greater number of

patients to Patient.co.uk than NHSC.

15%

65%

6%2%

11%15%

Do

n’t

kn

ow

ca

nt

rem

em

be

r

No

Oth

er

Bo

ots

We

bM

D

(ww

w.W

eb

md

.bo

ots

.co

m)

NH

SC

Pa

tie

nt

(ww

w.p

ati

en

t.c

o.u

k)

Has your GP or practice nurse ever printed materials or referred you to any other websites?

Base Used NHSC in conjunction with a GP visit = 1355 New question for 2012 survey


8%

71%

12%9% 9%

68%

13%10%

Do

n't

kn

ow

/

Can

't

rem

em

ber

No

- it

was n

ot

men

tio

ned

Yes -

I

men

tio

ned

it

Yes -

th

e G

P /

Para

cti

ce N

urs

e

men

tio

ned

it

2011 2012

35

Approximately two thirds of users reported NHSC has not been

mentioned during a GP/Practice nurse visit.

Has NHS Choices ever been mentioned

during a visit to your GP or Practice Nurse?

Has your GP or Practice Nurse ever printed

materials or referred you to the NHS Choices site?

• Don’t know / Can’t remember = 8 per cent

Yes - referred me to

the site

Yes printed materials

from the NHSC site

Yes – gave me the website

address and refer to it in

own time

No, never printed materials

or referred to the site

38%

15%

12%

40%

Base: Those who used NHS Choices + had NHS Choices mentioned = 311 Base Used NHSC in conjunction with a GP visit = 1355

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Summary


Executive summary 1: What is the impact of NHSC on GP visits?

What is the impact of NHSC on GP visits?

• Direct questioning in regards to the impact of NHSC on the number of GP visits revealed no change in the decrease of GP visits since 2011.

• However, indirect questioning uncovered these NHSC users (those who use NHSC

in conjunction with GP visits) have significantly decreased the average number of

GP visits per year and weekly GP visits since 2011.

• Discrepancies between what respondents say they do and what they actually do is not

uncommon

• 40% of these users agree NHSC enables self management of symptoms and GP

visits are not required.

• Those respondents who use NHSC BEFORE & DURING a GP visit show far

greater propensity to decrease GP visits.

• 70% of NHSC users utilise NHSC before a GP visit and 10% utilise NHSC during a

GP visit.

• NHSC has a significantly better impact on helping these users manage their own

symptoms & reducing the need for a GP visit BEFORE and DURING a GP visit vs.

those using NHSC AFTER a GP visit.

Findings correspond to the 49% users who use NHSC in conjunction with a GP visit (N = 1355)



How is NHSC used by the Public in relation to a GP visit?

• 75% of these users visit NHSC for themselves, however, there has been a

significant increase in usage for family members. This indicates NHSC is perceived

as a trusted and reliable source of health information amongst current users.

• Overall, becoming informed on symptoms/conditions/ treatments and deciding

whether to visit the GP top the list of reasons for NHSC use.

• Checking for symptoms/conditions & deciding whether to visit the GP remains the

main drivers to use NHSC BEFORE a GP visit.

• Checking for symptoms/conditions & understanding information given during an

appointment are the main drivers to use NHSC AFTER a GP visit.




How valuable is NHSC to the public?

• Vast majority of these users, including first time users, perceive NHSC information

to be valuable in supporting their healthcare needs.

• 80% of these users agree they are more knowledgeable & confident about their

health and treatment options.

• There is a significantly higher level of satisfaction with NHSC when used in

conjunction with a GP visit – higher than general site satisfaction.




What other health information sites do NHSC users use?

• Use of NHSC and other health information sites has significantly decreased since

2011, indicating that perhaps NHSC users have increased their health knowledge.

• Majority of NHSC users also use NHS Direct as an health information site.

• Approximately two thirds of users reported NHSC has not been mentioned during a

GP/Practice nurse visit.

• A significantly greater proportion of NHSC users reported GPs & Practice nurses

tend to refer or print materials from Patient.co.uk than NHSC, 15% vs. 11%

respectively.



Conclusions



Conclusions.

• Data supports NHSC has had a positive impact on increasing health knowledge and self

symptom management amongst users who use NHSC in conjunction with a GP visit.

• As a consequence there has been a significant reduction in the frequency of GP visits

amongst this group. Extrapolation suggests 1.8 million users have reduced GP visits as

a consequence of NHSC use.

• This research study has revealed NHSC has a greater impact on reducing GP visits

when used ‘before’ and ‘during’ a GP appointment rather than ‘after’ a GP appointment.

However an increase in health knowledge occurs when using NHSC ‘before’ or ‘after’ a

GP visit.

• It is worth noting NHSC has become a trusted and reliable source of information

amongst users who use NHSC in conjunction with a GP visit. Data shows these users

have decreased usage for themselves, reflecting the increase in health knowledge, but

have increased NHSC usage for family members.

• It is fair to conclude the use of NHSC alongside GP visits can potentially result in long

term cost benefits by

• Increasing health knowledge amongst the public

• Empowering patients to self manage symptoms and reduce frequency of GP visits

• Encouraging shared decision making between the GP and patients and enhance GP and

patient relationship

• Reducing length of GP visits


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