Register with a GP alpha assessment 2022
This is the report for the cross-government service assessment of the Register with a GP service at alpha. The assessment took place on 12 January 2022.
Service Standard assessment report
Register with a GP
| From: | Central Digital & Data Office (CDDO) |
| Assessment date: | 12/01/2022 |
| Stage: | Alpha |
| Result: | Met |
| Service provider: | NHS Digital |
Previous assessment reports
Service description
The ‘Registering with a GP surgery’ service will introduce a digital channel to supplement the existing offline paper-based process. Available to all practices in England, it will support all registration types and provide people wishing to register the ability to enter their data through the online service and submit to their chosen GP (doctor) surgery. It will allow GP surgeries to review incoming registrations and accept into their practice.
Service users
Two core user groups:
-
People who want or need to register with a new GP surgery
-
GP surgery workers who receive the registration and need to process it
Additional user group:
Primary Care Services England (PCSE) - processes new patient registrations and de-registrations at GP surgeries
1. Understand users and their needs
Decision
The service met point 1 of the Standard.
What the team has done well
The panel was impressed that:
- the team has taken a really good approach for building an understanding of such a large user group (people registering with GPs), and engaging with organisations to help bring seldom heard voices into the research and stretch the team’s thinking. Use of personas to help thinking about how to prioritise also seems very sensible
- the card sorting work looks like a really successful piece of research which shows how they are managing the competing needs of two core user groups, with the research providing a really well informed starting point for a key part of the journey
- it is great to see the use of ethnographic observational research observing users in a GP surgery for a week, and just how valuable this has been
- it sounds like the user researcher is doing a nice job of putting together impactful show and tells. Being able to bring GPs along to help amplify and strengthen what is being said to boost the impact of user research is great
What the team needs to explore
Before their next assessment, the team needs to:
- focus much more on research with users with access needs in beta. This is essential
- build up a better understanding of the GP systems themselves, and also of the exceptions the Primary Care Registration Management (PCRM) team is looking at. As identified by the researcher these seem like really important areas to research further in beta
- ensure the team makes the most of the pilot while it is running. For example can you do more observations or interviews with people from the practices where it is in place. Given the expressed challenge of accessing healthcare workers this seems like a good move (where appropriate and without overburdening them)
- think about additional research areas:
- GP surgeries that have specific populations (students, especially old populations, or maybe high numbers of homeless people) - to help stress test thinking around things like the questions being asked. Consider how easy it is for a GP surgeries to actually get patients to provide information at a later date
- Using GPs to understand if there are any clinical challenges with the approach they are taking (for example not having contact details captured as part of the registration process)
- People who are carers for someone else, or who might be doing a registration on behalf of someone else (also consider the impact of signing in to NHS account)
2. Solve a whole problem for users
Decision
The service met point 2 of the Standard.
What the team has done well
The panel was impressed that:
- the team has done really good work in mapping out the service ecosystem and identified the services which can complement or support solving the whole problem for the users
- the team is already working with existing services like Find a GP and NHS Login to share knowledge and requirements
- although the team has agreed to reduce the number of questions to the public by separating the health survey, they are keeping it a part of the service, so it doesn’t become another service somewhere else
- the team has a good understanding of their riskiest assumptions and throughout the presentation could demonstrate a clear understanding of how to address them now or in beta
- the team has shown really great service design work in how they have understood and positioned how their work sits and connects to related services, and not just focusing on the digital parts of the journey
What the team needs to explore
Before their next assessment, the team needs to:
- work with partnering services on detailed requirements that affect the whole service and agree priorities to resolve
- continue to work on solving the conflict with the need of the public and the GP surgery. The service needs to be desirable enough to be adopted by GP surgeries, by having the right type of questions and flexibility, but doesn’t ignore the person registering and what it feels like for them, not having too many questions
- continue to work closely with the PCRM team to understand exceptions
- ensure the data can be directly fed into the GP IT systems to reduce the burden on the GP surgery admin staff, or demonstrate any other solution is still solving the problem for the admin staff
3. Provide a joined-up experience across all channels
Decision
The service met point 3 of the Standard.
What the team has done well
The panel was impressed that:
- the team is also working on the offline paper forms and using the insights from online journeys to improve the offline journeys
What the team needs to explore
Before their next assessment, the team needs to:
- explore any other assistive channels to register with a GP and how they could be improved from this work
4. Make the service simple to use
Decision
The service met point 4 of the Standard.
What the team has done well
The panel was impressed that:
- the team has used the NHS prototyping kit and design system to build and iterate the prototype. This ensures accessibility and WCAG 2.1 AA compliance “out of the box”
- the team has a good understanding of reducing barriers, GP surgery catchment areas, ID card requirements, for example and understands what to address in beta for each
- content design was carefully considered, especially around NHS login
What the team needs to explore
Before their next assessment, the team needs to:
- continue to improve content to make it easy to understand, especially around NHS login
- conduct further content design and research on naming the service. The team already had a good understanding that not everyone may be familiar with the term GP, for example those with English as a second language
- make sure the version used for pilot (user research pilot) is also usable and accessible
5. Make sure everyone can use the service
Decision
The service did not meet point 5 of the Standard.
What the team has done well
The panel was impressed that:
- user research has included people with diverse needs, including those with access needs
- the intention is that everyone can use the service to register with their GP and thus access health care services
What the team needs to explore
Before their next assessment, the team needs to:
- test the prototypes with users with a range of access needs
- arrange an external accessibility audit
- ensure the technical frameworks used to build the service will not exclude anyone from using the service
6. Have a multidisciplinary team
Decision
The service met point 6 of the Standard.
What the team has done well
The panel was impressed that:
- the team included all the main roles required for alpha
- it is unusual to have two Product Owners (Delivery Manager and Service Designer) on a team as this can cause conflict on how a service should progress, however, this seems to have been managed during alpha even though it is unorthodox
- the Service Designer was very prominent on the team, which added value to understanding the existing landscape and ecosystem, and influencing where the new service should sit within this
What the team needs to explore
Before their next assessment, the team needs to:
- have a single Product Owner in place who can interface with the business and allow the team to focus on designing and developing the service. Currently, the Service Designer has a voice in business discussions and the direction of the service. The single Product Owner needs to continue to represent this voice as well as delivery
- embed a Performance Analyst in the team. They will have the right skills to create a performance framework aligning the problem statement with overarching goals, create user need based KPIs and utilise the right tools to measure and report on actual usage behaviour
- ensure there is a Clinical Lead involved in the programme
7. Use agile ways of working
Decision
The service met point 7 of the Standard.
What the team has done well
The panel was impressed that:
- the team is working using Agile principles including actively conducting appropriate ceremonies (for example stand-ups and show and tells)
- the team is using expected tools, including Confluence; Jira; Teams; Mural
- the team has maximised the use of show and tells by inviting representatives from GP surgeries. This has proved successful as it has enabled the team to learn more about GP systems and initiating a ‘fail fast’ approach
- the team is actively approaching user research as a ‘team sport’, involving the whole team and stakeholders in research activity and making insights available to all
- the team is reaching out to other NHS teams, including NHS Login and Find a GP. As Find a GP would be a key entry point to the service, they have been able to influence the postcode search results shown from geographical region to GP catchment area
- the team has been flexible enough to change focus on skill demand during alpha when a decision was made to build a pilot to assist with research purposes
- risk logs are maintained, and regular meetings are held with the Head of digital platforms; Senior Responsible Officers (SROs) and NHSx, and they are available as escalation routes, if necessary
What the team needs to explore
Before their next assessment, the team needs to:
- ensure that both the service design and technical teams are joined up. The service is for everyone and ways of working across professions should reflect this when solving a problem. It is important that what is delivered is driven by service design and not what is being developed in the pilot
- continue to work with teams across NHS Digital and share insights, including identifying problems that could be solved outside of the Registering with a GP service
8. Iterate and improve frequently
Decision
The service met point 8 of the Standard.
What the team has done well
The panel was impressed that:
- the team is working closely to agile principles that have enabled service iterations. Actionable insight has been gained from GP surgeries by the utilisation of a pilot for research purposes.
- the team has recognised the need for a full content review to make sure content is understandable but also to make sure there is consistency across other services
- a clean deployment pipeline is in place to merge features into a main branch
What the team needs to explore
Before their next assessment, the team needs to:
- design and develop the service at the right pace. As much as improving and iterating frequently is important, enough time needs to be allowed to do proper analysis of the research so its value can be maximised when iterating the service
- review and iterate content where necessary on the service and work with other service teams to make sure content is consistent
- continue testing the standardised set of questions during beta making sure they do not conflict with other services
- continue iterating and refining the service design and features on the back of user research including working with the Performance Analyst interpreting quantitative usage data of a private beta service
9. Create a secure service which protects users’ privacy
Decision
The service met point 9 of the Standard.
What the team has done well
The panel was impressed that:
- work had been undertaken to ensure minimal data was collected and not held longer than necessary
- the team is taking security and privacy seriously from the very start of the project.
What the team needs to explore
Before their next assessment, the team needs to:
- investigate using a threat model to get a better understanding of possible attack vectors, and potentially fraudulent use
10. Define what success looks like and publish performance data
Decision
The service met point 10 of the Standard.
What the team has done well
The panel was impressed that:
- the team has produced an initial set of KPIs and is thinking about service measurement
- the team is thinking how insight from other channels could be assessed to determine service success
- Hotjar is the tool selected to measure performance analytics. Hotjar will take into consideration cookie consent and protect personal identifiable information
- within the Data Protection Impact Assessment (DPIA), it is highlighted that data can only be accessed by those allowed to do so
What the team needs to explore
Before their next assessment, the team needs to:
- embed a Performance Analyst into the team
- evolve the initial KPIs to be more mature and meaningful for measuring service performance
- have a formal performance framework in place that starts with the problem statement and the goals the service needs to achieve
- build identified user needs into the performance framework and how these are going to be measured
- create dashboards for measuring actual usage of the online service for private beta, and for when the service is launched at scale
- tie actual usage data back to identified user needs as a quantitative measure of whether needs are being met (or not)
- integrate performance analysis into team ways of working
- consider how Cost Per Transaction data can be calculated
- investigate publishing performance data on data.gov.uk
11. Choose the right tools and technology
Decision
The service met point 11 of the Standard.
What the team has done well
The panel was impressed that:
- the team has investigated alternative architectural approaches to building services
- the backend has been designed with scalability in mind
What the team needs to explore
Before their next assessment, the team needs to:
- ensure that users without Javascript are able to use the service, using the recommended progressive enhancement approach
- ensure the choice of front-end framework does not negatively affect accessibility, and that adding support with that framework does not take longer than using another approach
12. Make new source code open
Decision
The service did not meet point 12 of the Standard.
What the team needs to explore
Before their next assessment, the team needs to:
- provide public access to the service source code (without configuration data that should be kept private) under an appropriate open source licence
13. Use and contribute to open standards, common components and patterns
Decision
The service met point 13 of the Standard.
What the team has done well
The panel was impressed that:
- the team is making use of common components both within the NHS and also from wider government
What the team needs to explore
Before their next assessment, the team needs to:
- investigate whether there are any patterns they are discovering that could be contributed back
14. Operate a reliable service
Decision
The service met point 14 of the Standard.
What the team has done well
The panel was impressed that:
- the team investigated alternative architectures that could reduce the number of moving parts to be maintained
- steps had been taken to ensure the service would continue to run even if some of the external dependencies were not available
What the team needs to explore
Before their next assessment, the team needs to:
- explore where there are further observability metrics that could improve the team’s ability to manage any future incidents
- ensure that data entering the system is validated on the servers, as well as on the front-end
Next Steps
This service can now move into a private beta phase, subject to implementing the recommendations outlined in the report and getting approval from the CDDO spend control team. The service must pass public beta assessment before launching public beta. Speak to your Digital Engagement Manager to arrange it as soon as possible.
To get the service ready to launch on GOV.UK the team needs to:
- get a GOV.UK service domain name
- work with the GOV.UK content team on any changes required to GOV.UK content