Beasley et al1 in their editorial describe how the implementation of electronic health records (EHR) is a transformative change. Some practices have made that transformation. For example, Amir Hannan and colleagues at Harold Shipman's previous practice at Haughton Thornton Medical Centre (http://www.htmc.co.uk), not only use EHR but offer their patients many e-health facilities, such as access to their own records, booking of appointments, repeat prescriptions, advice on preparing for the consultation, as well as links to numerous resources both locally and nationally. GP system suppliers provide patient directed web-based functions, such as repeat prescribing and patient access to records that, technically, just need to be ‘turned on’. However, practices using these functions are in the minority. A third of practices have yet to offer their patients use of a practice website.
We examined the geographical variation in practice website provision in August 2011. We used data from NHS Choices on 8399 practices in England. We chose a purposive sample of 1026 practices in 14 postcode areas across England that were likely to include areas with high, medium, and low provision of GP websites. We used practice name and address to search Google™ for a practice website. The accuracy of searching was checked by an observer variation study on a sub-sample of 50. There was agreement on 46/50 (Kappa = 0.81).
Two-thirds (676/1026) of practices had a website that could be found on Google. This varied from 94% (all but one practice) in Harrogate to 35% in Southend (Table 1). We did not assess the functionality of the websites but anecdotally know that many websites were just ‘electronic nameplates’ rather than functional sites for patient use.
Table 1.
Website provision
| Postcode | No website | Website | |
|---|---|---|---|
| area | n (%) | n (%) | |
| Harrogate | HG | 1(6) | 16(94) |
| Taunton | TA | 5(10) | 43 (90) |
| Southampton | SO | 10(13) | 68 (87) |
| Bristol | BS | 19(16) | 100(84) |
| Halifax | HX | 5(22) | 18(78) |
| Plymouth | PL | 18(22) | 64 (78) |
| Sunderland | SR | 13(26) | 38 (74) |
| StAlbans | AL | 6(26) | 17(74) |
| London SW | SW | 48 (32) | 101 (68) |
| Leeds | LS | 47 (39) | 73(61) |
| Fylde | FY | 23 (50) | 23 (50) |
| Blackburn | BB | 48(51) | 46 (49) |
| Wakefield | WF | 39 (55) | 32 (45) |
| Southend | SS | 68 (65) | 37 (35) |
| Total | 350 (34) | 676 (66) | |
Discussion about digital health inequalities tends to focus on the access that patients may have to the internet or in their ability to use it,2–4 but there are clearly inequalities in the provision of opportunity to use e-health. The online facilities that are offered at some practices should be offered to all and should be considered a mark of a quality practice. Primary care trusts or GP cooperatives or whoever is now responsible in areas such as Southend, Wakefield, Blackburn, and Fylde should examine why their patients should have such poor opportunity for e-health. We need to explore with all stakeholders in primary care — GPs, their staff, but also patients and carers — the opportunities and barriers to implementation of e-health methods.
Conflict of interest
We are all patients in primary care.
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