Table 5. Summary of changes: consultation summary report.

	Issue identified	Feature added
External Issue	The initial intervention was conceived for face-to-face appointments including printed advice. After March 2020 most appointments were by telephone so this wasn’t possible.	Changed the process design and the user guides so that the report could be either printed, sent via accuRX or email.
PPI / Patients	The original version of the summary report had four sections. The PPI group found this visually confusing and suggested combining sections. Patients subsequently suggested dropping the final section of “problems raised today”.	Report reduced to two sections: ▪    Plans and advice from today ▪    Next steps
PPI / Patients / GPs	Some GPs thought the report should directly address the patient from the GP. Because of the low number of patient interviews, we ran a two-step PPI process: a) we elicited feedback on the wording through a PPI meeting b) based on this feedback, we presented PPI members with options to select their preferred wording from.	Extensive wording changes were made to make the language more patient- centred (e.g. stool was changes to “stool (poo)” and to make the report address the patient from the GP: (e.g. “contact our reception team” instead of “contact your GP reception” and “I have referred you” instead of “we have referred you”
Patient	The original report sent to patients was difficult to read as it was in paragraphs. Although most of them found it useful, patients felt it would be easier to read and to talk to their carers about if it was a bulleted list.	We were aware of this issue early on but it was technically difficult to solve. A solution was devised in Round 3, which involved GPs installing a bespoke macro to format the report once it was generated.
GP / Patient	Where medication changes are indicated these were not clear.	Added an optional section for medication changes.
GP	The initial version of the EMIS protocol used three templates. This required the GP to select in advance whether they were ordering “no tests”, “one test” or “two tests”. The two-test version was heavily free text based.	A single template was developed, no matter how many tests were ordered with mainly tick box questions throughout. This also relied on development of the macro which GPs installed on their computers.
GP	There was only one box for advice to patient. Some GPs ran out of space and wanted to put advice each problem on a separate line.	Adjusted so that there are three advice boxes. Only the first is compulsory to complete.
GP	The original version had default text for booking tests which GPs overwrite e.g. “contact reception to book your X test”. GPs found they were always overwriting the same things, so suggested the text default to a standard.	Put the most common ways of booking tests e.g. “please bring in a sample for your urine test”, “phone 0141 332 4345 to book an X-ray appointment.” This was customised for each practice.
GP	The template works by writing codes into the patient notes. Another clinician reading the notes may be confused by this.	All COAC clinical codes written to comments section of EMIS. A research code is added with text: “ This patient participated in the COAC Study. These codes were used to create a report which is attached to the record below.”
GP	Would be useful to indicate use the template for fast-track referrals.	Added fast-track referral text
GP	Would be useful to direct patients that the NHS app is another option for viewing test results	Add optional tick box “you can also view your results on the NHS app”
GP	In the training sessions, GPs noted that some of the free text did not apply to policy in their practice (e.g. phone number for referrals).	Customise the free text in each box for the practice policy after the GP training session.