FOI 2025/1402

Under the Freedom of Information Act 2000, I am writing to request further information to better understand how older adults are accessing GP services within your ICB area, particularly in light of the shift towards a “digital by default” approach as part of the NHS 10-year plan.

Please provide the following information in relation to your ICB area:

1. Mitigation measures in your ICB:
The steps your ICB has taken to ensure that older adults are not disadvantaged by the shift to “digital by default” within the NHS 10-year plan.

2. Examples of good practice:
Please provide examples of good practice from GP surgeries in your area that specifically support access for older people, including initiatives to maintain or enhance face-to-face access and ensure they are not adversely affected by the move towards “digital by default”.

3. Complaints:
Data on the number of complaints submitted in relation to difficulties booking GP appointments in your ICB area between 1st April 2024 and 31st March 2025?

If you know of a GP practice in your area that you believe exemplifies outstanding involvement of older people, we would be grateful if you could share their contact details so we may get in touch with them.

1. Mitigation measures in your ICB:

One of the 3 key shifts set out in the 10 Year Health Plan is From Analogue to Digital.  It recognises that a lot more of our daily lives are supported by modern technology, for example banking, shopping and media. The plan acknowledges that the health service is not as far forward in terms Digital capabilities both in terms of the hardware and software that is available and enabling people to have digital tools to help them take control over their health.

The ICB recognises that in a number of circumstances, and for different equality groups, there will be considerations around access to health and care services to best meet patient needs. For example, digital service access may not be inclusive or may at times cause unintended disadvantage when not implemented in an equitable way.

As an ICB, NHS Greater Manchester (NHS GM) is upgrading the Equality and Health Impact Assessment (EHIA) and evidence gathering to incorporate the potential for capturing and addressing adverse impact directly from the use of digital and artificial intelligence (AI) solutions in health and care and employment. This will strengthen the mitigations required to ensure that digital advances do not, unintentionally or otherwise, widen health inequalities. We also have explicit reference in the EHIA as to what is being done to ensure that we meet the Accessible Information Standards. This approach is intended to improve proposals in respect of the digital divide, whether that be related to age, disability, poverty or other related barriers to digital service provision.

In alignment with NHS England’s refreshed 2025 Accessible Information Standard (AIS), we are actively reviewing how best to implement the newly introduced sixth “Review” stage, which aims to strengthen compliance. The ICB is considering the adoption of a self-assessment framework aligned with Care Quality Commission (CQC) assessments to support assurance processes and provide clearer guidance and role clarity for commissioners and providers. This work is part of a broader commitment to ensuring that older adults are not digitally excluded by initiatives that fall within the from analogue to digital shift within the NHS 10-year plan. It will pay particular attention to inclusive communication and equitable access.

2. Examples of good practice:

NHS GM have a Digital Facilitator team that regularly run community events to support citizens with the use of digital technology in health and care. These events reach different population groups including older people. These events are often held in community venues such as libraries, health and community centres. They are often done working with locality colleagues who focus on patient empowerment and inclusion. For example, patient testimonials from older adults at a community event in Bury indicated that their introduction on the NHS App was very positive, enabling them to see blood test results without having to phone the GP and for ordering repeat medications. These types of community events also have been acknowledged for increasing digital confidence and literacy for those involved, more broadly than just in respect to health and care engagement (such as increasing take up of digital banking, etc).

The GM Digital Facilitator Team also work with practices and Primary Care Networks (PCNs) and since January 2024, have held over 170 sessions to support practices with virtual triage of patient requests (online, telephone or walk-in).

There is a network of digital champions across our GM GP practices who are on hand to support any patients who do have queries or challenges when using digital.  It is important to emphasise that other routes to care have not been removed.

The Modern General Practice (https://www.england.nhs.uk/gp/national-general-practice-improvement-programme/modern-general-practice-model/ ) access model as set out in the NHS England Primary Care Access Recovery Plan, is what GP practices have been implementing over the last few years. The intention is to create parity of access between online, telephone and walk-in contact.  Whilst many practices have offered online access for some years, it has not actually become a contractual requirement until 1st October 2025.  Online systems should be open for the duration of core hours (8am-6:30pm), in the same way that telephone or walk-in access would be. Therefore, whilst there may be a perceived shift to ‘digital by default’, there continues to be choice for patients to contact the practice and equality of access to General Practice through online means, telephone or walk-in.

In response to the challenge of digital exclusion, Greater Manchester has developed an innovative tool: the Digital Exclusion Heatmap. This Heatmap offers a clear way to understand where digital exclusion is most severe and helps direct support to where it’s needed most. More on this can be read in the Department for Science, Innovation and Technology Digital Inclusion Action Plan – First Steps (https://assets.publishing.service.gov.uk/media/67bdc3edb0d253f92e213c47/digital_inclusion_action_plan_first_steps.pdf – February 2025).

With a complex healthcare landscape spanning over 406 general practices and 65 Primary Care Networks (PCNs), the Heatmap is a key tool to address the unique challenges of the region and is part of an intelligence driven primary care approach in Greater Manchester. It aligns with Greater Manchester’s Digital Inclusion Agenda, launched in 2020, which aims to make the city region fully digitally enabled.

Regarding face-to-face access to services, approximately 65% of all GP appointments from September 2024 to August 2025 were face to face appointments. Under the GP contract, GP practices are expected to deliver core and enhanced services that meet the needs of its patient population. There is variation across Greater Manchester in terms of appointment modality, with face-to-face appointments around 80% in some practices, whilst nearer to 50% in others. NHS GM Primary Care commissioners continue to work with practices to ensure they meet population needs and take into account digital inclusion standards, such as those produced by NHS England.  NHS England » Supporting digital inclusion in general practice: 10 top tips (https://www.england.nhs.uk/long-read/supporting-digital-inclusion-in-general-practice-10-top-tips/ )

NHS GM do not hold a centralised record of good practice from GP surgeries across Greater Manchester in terms of supporting access specifically for older people.

3. Complaints:

During this period NHS GM has received 29 complaints associated to difficulties booking GP appointments, however, these are not specific to digital exclusion or face to face access.