Table 1

What did the codesign process change?

Ideas or learning identified by participantsChange to the process
Near Me may not be accessible for patients due to its technical specificationProvided information about the technical specification on the Near Me website
Near Me platform provider has lowered bandwidth requirements to improve accessibility—technical requirements are low
Patients’ equipment may not be compatible with Near Me systemAdded a ‘line check’ step into the process before first scheduled appointment
Need to provide support for patients who encounter difficulties with using Near MeTelephone support in place (local number first but as a team of two insufficient, national back-up added)
Introduced Friday afternoon virtual ‘drop in’ sessions for anyone wanting to try out accessing Near Me for an appointment from home
Link made with charity AbilityNet who will support individuals with technical difficulties on a one-to-one basis
Concerns over security of system and privacyIncreasing awareness of safeguards in place (local and national) and highlighting that there is no recording of consultations
Unexpected connectivity issues on the day of the appointmentText reminder sent trigger patient to check connection
Telephone consultation used as a contingency
Near Me information leaflets not fully understoodPosters and leaflets about NHS Near Me were tested and codesigned with participants and distributed across NHS Highland
Patients did not know what to do when their call was not connected quicklyInformation added to the main NHS Near Me reception waiting screen which included a phone number to call if not answered within a specific time frame
Capacity doubled at the Near Me reception process by installing a second computer terminal
Provide a direct link so that once people click on their appointment it will take them directly to the receptionist
Provide a Near Me app
Single point of access for all appointments, so specific links are not needed:
This is sent in text reminders (appointments are by letter not email)
Patients can add a shortcut to the webpage to their phone/tablet, which is faster than an App.
Patient and clinician decisions
Video appointments are not always clinically appropriate. Concerns highlighted included patients receiving difficult news, some mental health conditions and the need for physical examinationClinician makes the decision whether to offer, or not, Near Me on an individual appointment basis and the patient can choose to opt out
Patients may not get a choice over whether to use Near Me or have an in-person consultationThe method of returning appointments should be discussed between clinician and patients, allowing the patient to choose. For new appointments, patients will be contacted to allow them to opt out of the Near Me option and choose a traditional appointment
Concerns over the technology being too difficult for some people to useStaffed NHS Near Me rooms set up where people can go to have a member of NHS staff support them to call, that is, Local GP practice
Suggestion to register patients with the Near Me service so only these patients are offered consultation using Near MeAfter exploring this, it became apparent that this was not a suitable option. It would have prevented patients from being offered a Near Me appointment who had not heard of the system previously and it there was not a complete list of patients to contact to offer the service. However, learning from this initiated a new system of annotating patients records as to whether they had opted for Near Me appointments. This remains a patient choice as they can still request a physical face-to-face consultation
Near Me enables patients to have a family member or friend presentAll clinicians are made aware of this function in training so they can offer it to patients
Patients and patient groups informed whenever there is an opportunity to discuss Near Me
Spread use
Patient suggestion to promote NHS Near Me from ‘word of mouth’ using the patient experiencePatient stories have been captured and shared anonymously via the press and social media. A short film has been made with a patient
Lack of awareness among secondary care clinicians—participants recommended face-to-face meetings with clinicians to encourage them to offer patients the Near Me optionEvery clinical service in NHS Highland was contacted and offered to meet to discuss NHS Near Me. There are now 27 services providing Near Me appointments, with more meetings to follow.
Obtain buy-in from local clinicians—patients said this was essential as patients are more likely to trust a local clinician whom they knowInformation sent to all GP practices across NHS Highland. Meetings held at some GP practices. Difficult to visit all practices due to the number of practices and geography. Alternative meeting options are being explored, that is, web casting.
Continue to evaluate Near Me to gather further feedback and adapt as requiredA patient feedback survey was added to the NHS Near Me system, which pops up automatically after each call.
  • GP, general practitioner; NHS, National Health Service.