Ease of access to general practice, patient experience and use of the NHS App: an ecological analysis of English data

Summary Objective To assess the relationship between GP experience, phone and website access measures, and NHS App use. Design An ecological study using practice-level NHS App usage data between March 2020 and June 2022. GP practice codes were used to link patient-reported experience and ease of access scores from the General Practice Patient Survey to the NHS App data. Practices were grouped into five quintiles based on experience and access measures, and negative binomial regressions were used to estimate Incident Rate Ratios (IRR) comparing NHS App usage across quintiles. Models were adjusted for age, sex, deprivation, ethnicity and long-term healthcare needs. Setting General practices across the NHS in England. Participants Patients registered at 6386 GP practices in England. Main Outcomes Weekly rates of NHS App functions used (registrations, logins, prescriptions ordered, medical record views and appointments booked) per 1000 GP-registered population. Results Fully adjusted models found lower NHS App use in practices with the highest patient experience. Registration rates were 3.5% lower in practices with the highest vs. lowest experience scores (IRR 0.96, p < 0.001) and logins were 5.2% lower (IRR 0.95, p < 0.001). Practices with better phone access had 27.0% higher prescription orders (IRR highest vs. lowest = 1.27, p < 0.001), and 57.8% higher appointment bookings (IRR highest vs. lowest = 1.58, p < 0.001). Prescriptions were 7.7% higher in practices with the highest vs. lowest web access scores (IRR 1.08, p < 0.001). Conclusion NHS App use was lower in practices with the highest patient experience, but generally higher in practices with better phone and web access. Results highlight the need for coordinated action to improve access and patient satisfaction.