Table 2. Summary characteristics of participating practices.

Practice	Description
Camp St Group Deprivation decile: 6 th Digital maturity •••• List size: 31,000	This group practice is in a southern English commuter town, about 20 miles from a major city. It spans three sites; all share one computer system. There are 15 partners and 40 additional staff including paramedics, one advanced clinical practitioner, six nurses, four pharmacists, four healthcare assistants and many support staff. Their population is ethnically and socio-economically diverse with affluent and low-income populations living in adjacent streets. Various digital innovations have been piloted and some but not all have been retained.
Carleon Deprivation decile: 2 nd Digital maturity • List size: 7500	This rural practice covers three sites in north Wales. Each site serves a different demographic—from picturesque retirement villages close to a National Park, farming communities to some of the most deprived boroughs in Wales. There are 5 part-time GP partners, two registrars, and relatively few attached staff (two advanced nurse practitioners and two practice nurses) plus a pharmacist working remotely from England. Carleon is a teaching and training practice and is responsible for a community hospital. Digital provision is currently limited (and restricted to telephone), partly because both staff and patients seem to prefer traditional in-person appointments. However, demand is high and rising and whilst the current system is described as “not really working” (hence there is some tension for change), the direction of change is not yet clear.
Fernleigh Medical Group Deprivation decile: 9 th Digital maturity ••• (approaching ••••) List size: 15,000	This well-resourced 7-partner dispensing practice in central southern England serves a mainly affluent and elderly population. The staff of 40 includes 7 salaried GPs with many staff in non-medical clinical roles, freeing the GPs for more complex patients and extended roles. The practice prides itself for being innovative in terms of both processes and technology, and for being involved in a range of non-core activities such as training, undergraduate teaching, research and working with the local community. Many of these mainly elderly patients are not comfortable using online contact methods.
Newbrey Surgery Deprivation decile: 9 th Digital maturity: between •• and ••• List size: 21,000	This suburban practice lies on the outskirts of a university city in central England, with 5 GP partners. A staff of around 30 includes 9 salaried GPs, one advanced clinical practitioner, six nurses, two paramedics, one social prescriber, one care co-ordinator, several healthcare assistants and a large administrative team. It serves a relatively affluent population (young professionals, healthcare workers and their families), but also has some postcode pockets of deprivation. The practice struggled recently with unmanageable demand, experienced telephone triage as inefficient (because of double- handling), and has introduced a proactive patient booking team aimed at giving as many patients as possible their preferred appointment type.
Ogden East Deprivation decile: 1 st Digital maturity: • List size: 8300	This practice serves a deprived borough in a city in western England. It has two full-time GP partners and five salaried GPs, plus a wide a range of other clinical staff and administrative staff. It is a teaching and training practice. 88% of patients are white; many are in the lowest socio-economic decile and include homeless people and travellers. A high proportion have complex co-morbidities and many have low health and digital literacy. The practice provides a drug and alcohol service. They strive to be patient-centred and allow patients to select their preferred appointment type. They have introduced some digital modalities (including online consultations which they found generated high workload). They are keen to avoid digital exclusion of vulnerable patients. Plans include introducing some kind of remote triage.
Queens Road Deprivation decile: 7 th Digital maturity: ••• List size: 13,000	The practice, in a small city in Western England, has a mixed socio-demographic and serves a high number of people with refugee status. It has the highest usage of the telephone interpreting service Language Line in the region. It has two GP partners and four salaried GPs, with a range of allied clinical and administrative staff. It provides a drug and alcohol service and a chronic pain clinic that offer non-medical solutions to patients on prolonged opiate use. The practice has multiple routes of access (online booking system, telephone, and an online consultation platform). It works flexibly around the needs of patients with known vulnerabilities (i.e. homeless and people with learning disabilities) by enabling them to make appointments at the front desk and offering in-person double appointment slots. There is an expectation that patients without additional needs will adapt to the remote triage system. These changes are met with some resistance by patients (and staff perceive some hostility) but the practice believe that digitisation of services for the majority will help meet rising patient demand.
Range Park Deprivation decile: 1 st Digital maturity: • List size: 2300	This small practice in a major city in central Scotland has two GP partners, an attached community link worker and a district nursing service. It serves a population that is 88% white with high socio-economic deprivation, low health literacy and many young families. Patients have high levels of illness and comorbidities linked to social determinants, with high rates of drug and alcohol use. The lead GP, who is active on local and national primary care committees, has a longstanding presence in the community and knows many patients and families well; consequently, she is confident managing many consultations by telephone. Receptionists make triage decisions. The practice has no plans to expand its digital services. Rather, its priorities are to improve outreach and support to the local population through non-digital means.
Rhian Deprivation decile: 3 rd Digital maturity: •• (aspiring to •••) List size: 11,500	This teaching and training practice in a small south Wales town has a village branch surgery three miles away. There are five GP partners, two salaried GPs, four nurses, two healthcare assistants and an on-site pharmacist. Some staff have been there over 20 years, though several partners are currently on breaks or soon to retire. The population is relatively deprived; it includes a former coal mining community as well as a growing number of young professional families relocating to a large new housing estate and retired people. Patients can currently ask for their preferred consultation type, which is triaged by receptionists. Rhian was an early digital adopter 20 years ago but more recently has fallen behind (see ‘Innovation and digital maturity’). The new business manager is keen to make changes, bring people with him, rework the staffing structure and appointment systems, and find digital solutions that “click together”.
River Road Deprivation decile: 1 st Digital maturity: ••• List size: 5500	This practice (list size 5,500) serves a young and ethnically diverse population in a very deprived borough on the outskirts of a major city in southern Scotland. The practice is housed in a modern complex that includes a library, leisure centre and various social services. There are four part-time GP partners, one nurse, one healthcare assistant, one community link worker, and aligned health visitors and district nurses—but no advanced nurse practitioners, paramedics or pharmacists. It is a teaching and training practice and strongly committed to serving the local community. Many patients have complex needs and low health literacy. Recent introduction of e-triage has greatly reduced stress among reception staff but added to the GPs’ workload.
Towerhill Deprivation decile: 8 th Digital maturity: •••• (approaching •••••) List size: 15,800	This four-partner teaching and training practice is sited in a fairly affluent borough in a major city in south-east England. It has three salaried GPs, five physician assistants, an advanced clinical practitioner, a pharmacist, three business managers and various administrative staff. Partners are active in the Clinical Commissioning Group, Primary Care Network and GP Federation. The practice ethos is contemporary—a young, ethnically diverse and digitally-savvy group of GPs (“we’re interested in the new and shiny”) serving a population with a similar demographic. Staff value quality of care and evidence-based practice. They are keen to innovate and embrace change, and they enjoy state-of-the-art premises, IT infrastructure and numerous digital technologies. A high proportion of consultations occur remotely. Patients may only contact the practice online; those who telephone are talked through a digital template. However, some support staff are concerned that the less digitally literate patients are being overlooked, and have shared stories about patients ending up in Accident and Emergency because they could not access the practice.
Westerly Deprivation decile: 2 nd Digital maturity: ••• List size: 27,000	This large teaching and training practice lies on the outskirts of a major city in southern England. There are six GP partners, six salaried GPs, two registrars plus 30 staff including 7 nurses, two pharmacists, three managers, and a large and well-differentiated reception and support team. Historically, the practice served a deprived population but the area is rapidly becoming more socio-economically mixed due to extensive property building in the area. It is very ethnically diverse; many patients are limited English speakers and there is a high use of the Language Line interpreting service. There is a strong emphasis on continuity of care. Access is primarily by telephone and the NHS app, through which patients can book slots for telephone or in-person appointments. There is also a daily walk-in clinic. The emphasis is on patient choice rather than strict triage. However, telephone contact is currently very high; reception staff are stressed and feel that demand is unsustainable. Current priorities are rationalising the appointment system, replacing the phone system, and addressing staff wellbeing.