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The importance of websites

HEATHER MACFARLANE AND MATTHEW BULTITUDE

The authors emphasise the

importance of maintaining
up-to-date and comprehensive
information for patients on
both general practice and
hospital-based websites.

ur methods of communication have

O changed dramatically over the past
20 years, with a revolution in the way in
which we display and receive information.
The origins of the internet can be traced
back to the 1960s, but it was only in the
1990s that it became established in
widespread use, and access to the web
continues to grow.

The number of internet users worldwide

doubled between 2005 and 2010, to reach
two billion.1 In the UK, 77 per cent of the Figure 1. The NHS Choices website
population are internet users, with 30

‘
million accessing the internet every day.2
The importance of internet access is Think like a wise man but communicate in

shown by the fact that a number of
countries, including Finland and Spain,
have declared internet access a legal right
for their citizens. Mobile internet access
is also rising fast, with 940 million users
worldwide.1 In the UK in 2011, 17.6 million
people used their mobile phone to access
the internet compared to 8.5 million
in 2009.3
It is vitally important that, as medical
professionals, we offer the information
and services that our patients require and
expect. Other businesses use the internet
to advertise and attract business. With
patient choice an increasingly important
part of government health policy, websites
’
the language of the people
William Butler Yeats (1865–1939)
allow patients to view a GP surgery or
hospital in advance and therefore choose
(where available) which services to use.
The more professional a website looks,
the more likely a patient is to choose that
service. Private hospitals recognise the
importance of this, and their websites Heather MacFarlane, BSc(Hons), Medical
are generally better designed and more Student, King’s College London School of
user-friendly than NHS websites. Medicine; Matthew Bultitude, MB BS,
MRCS, MSc, FRCS(Urol), Consultant
NHS CHOICES WEBSITE Urological Surgeon, Guy’s and St Thomas’
Progress has been made in recent years, Hospital, London
with NHS Choices offering a central portal

TRENDS IN UROLOGY & MEN’S HEALTH MARCH/APRIL 2012 www.trendsinurology.com

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for information on the NHS and its services
Oxfordshire PCT
(Figure 1).4 This is a well-designed and
simple-to-use site containing many types Total number analysed 53
of information, including: Number with a website 39 (74%)
• an A–Z of conditions
• a symptom checker CONTACT DETAILS
• medicines A–Z, allowing patients to look Opening times 39 (100%)
up their medication Details for enquiries 39 (100%)
• topics on healthy living Details for appointments 39 (100%)
• health news Contact by email possible 15 (38%)
• local health services. Address of practice 39 (100%)
Map of practice 28 (72%)
The local health services section includes
links to all local services, including GP STAFF DETAILS
surgeries within the primary care trust GP: list 35 (90%)
(PCT), emergency services, hospitals, GP: profile 15 (38%)
pharmacies, dentists, opticians and local GP: picture 12 (31%)
sexual health and smoking cessation Practice nurse: list 28 (72%)
services. If available, there are then Practice nurse: profile 8 (21%)
direct links to individual GP practices Practice nurse: picture 2 (5%)
and hospital websites. Manager: list 21 (54%)
Manager: profile 3 (8%)
NHS HOSPITAL WEBSITES Manager: picture 3 (8%)
The senior author recently reviewed the
websites of all NHS urology departments Table 1. Number of GP websites with contact and staff details
in England.5 Hospital information was
obtained from the comprehensive list of In addition, there were very few websites
hospitals on the NHS Choices website. The with information on conditions and
results show that NHS hospital websites procedures; however, it may be that
require a lot of work. Thirty-three per cent this is available centrally on the NHS
of the websites of hospital trusts with Choices website. This avoids the need
urology services had no information on to keep content up to date on multiple
these services. Of the hospital websites websites. Very few websites had
with urology information, 59 per cent had embraced e-communication, with only
only one page and most were very brief. two offering online forms as a method of
Relatively few provided contact details or communicating with the department.
clinic and ward information, which is key
information that patients would use a GENERAL PRACTICE WEBSITES
website to look for. We recently audited patients attending
different urology clinics in our department.
Readers are reminded that they must take Of 184 responses, two had no GP and nine
responsibility for all information that they give knew that their surgery did not have a
to patients, whether written information in website. Of the remaining 173 patients,
clinic, on a website or via social media. only 32 (18 per cent) had ever visited their
Incorrect information may be dangerous, for GP’s website. However, a similar proportion
which the authors may be liable, and any had visited our departmental website.
patient information, even if it does not include
the name, may break confidentiality and lead We then reviewed a selection of GP
to disciplinary action. This applies even if websites to assess how they are promoting
posted under a pseudonym. their services. To ensure there was no
bias from choosing an inner-city or
www.trendsinurology.com
Southwark PCT
27
16 (59%)
16 (100%)
16 (100%)
16 (100%)
3 (19%)
16 (100%)
11 (69%)
14 (88%)
0 (0%)
2 (13%)
14 (88%)
0 (0%)
1 (6%)
13 (81%)
2 (13%)
1 (6%)
country PCT, we compared Southwark and
Oxfordshire PCTs. The list of GP practices was
obtained from the NHS Choices website.
Because of the number of practices, we
analysed alternate practices from the list
using a set proforma. It was noticeable
that GP practices have embraced websites
for patient information better than
urology departments and also have
some interactive services – mainly
for repeat prescriptions. This is not
surprising, as reordering prescriptions
easily lends itself to a website function
and potentially frees up administrative
staff in the practice.
In total, 80 GP practices were analysed
(53 in Oxford, 27 in Southwark). Of these,
69 per cent had their own websites (we did
not include information on the NHS
Choices page). Oxford practices were more
likely to have a website, with only 26 per
cent not offering one compared to 41 per
cent in Southwark.
TRENDS IN UROLOGY & MEN’S HEALTH MARCH/APRIL 2012
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Oxfordshire PCT
List of different services 35 (90%)
Minor procedures 22 (56%)
Downloadable patient leaflets 12 (31%)
Emergency visit information 30 (77%)
Out-of-hours services 35 (90%)
Home visits 32 (82%)
Test results 27 (69%)
Repeat prescriptions 33 (85%)
Children/newborn 26 (67%)
Travel advice/vaccinations 22 (56%)
Reduce smoking campaigns 16 (41%)
Sexual health 17 (44%)
Family planning 16 (41%)
Table 2. Number of GP websites offering different services
We then analysed the information available
on the sites. Most gave information on
staff, although only 27 per cent had a
profile for the GP, with a similar proportion
having a picture of the GP. Seventy-six per
cent had practice nurse details, but only
15 per cent had a profile for the nurse
and very few (5 per cent) had a picture.
Management was listed on 62 per cent of
sites, but very few had a profile or picture
(Table 1).
Almost all (93 per cent) gave a list of the
services that were offered at that practice,
with 61 per cent giving an explanation of
what they were; 36 per cent offered
downloadable patient information leaflets
(Table 2). The details on specific services
were fairly mixed: children/newborn,
58 per cent; travel vaccinations and advice,
49 per cent; smoking cessation, 36 per
cent; sexual health, 36 per cent; family
planning, 36 per cent; 20 per cent offered a
section on frequently asked questions.
It was difficult to rate websites on how
visually appealing they were; however,
the use of pictures was noted. Thirty-one
(56 per cent) had less than one picture
per page on the site, with only eight
(15 per cent) having more than one
picture per page, which we thought was
probably desirable.
TRENDS IN UROLOGY & MEN’S HEALTH MARCH/APRIL 2012
Southwark PCT
16 (100%)
4 (25%)
8 (50%)
12 (75%)
13 (81%)
11 (69%)
10 (63%)
12 (75%)
6 (38%)
5 (31%)
4 (25%)
3 (19%)
4 (25%)
Surprisingly few websites provided key
information that patients would look for,
such as:
• process for emergency appointments
(76 per cent)
• out-of-hours service (87 per cent)
• home visits (78 per cent)
• obtaining test results (67 per cent).
We believed that the availability to
reorder prescriptions (82 per cent) was
a useful function.
As we would expect, all websites gave the
opening times of the practice and all had a
contact telephone number for enquiries
and appointments. Seventy-one per cent
gave a map of the practice location and a
disappointing 33 per cent allowed contact
by email.
It is important that websites are accurate
and it is generally better to have less
information that is current than a large
amount of information that is outdated.
It was impossible to judge whether the
information on the websites we reviewed
was accurate. However, we did note
that only 5 per cent specified a date
of last update. This is a simple feature to
add to a website and, if current, implies
that the site is checked regularly and is
up to date.
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We identified whether sites allowed
feedback, either about the services received
or the website. Sixty-nine per cent did give
information on how to give feedback or
make a complaint. However, only 13 per
cent allowed this to be done online.
Finally, we looked to see whether the sites
we visited had embraced more modern
methods of communication such as
podcasts or use of social media (Facebook
or Twitter). Seven (13 per cent) had podcasts
on their website, with only one advertising
that they had a Twitter page and none
offering Facebook. This is probably not
surprising, although we feel that this is
a huge opportunity for GP surgeries to
offer health-related information to their
patients. One could imagine the surgery
‘tweeting’ regularly on a number of areas,
such as opening times, staff leaving or
joining, importance of and reminders to
get a flu jab, asking for feedback, and
health promotional messages, eg stop-
smoking campaign. While it may seem
that few patients use this technology, it
may encourage them to try it.
CONCERNS ABOUT USE OF
SOCIAL MEDIA
Use of social media is rising at an
extraordinary pace. Facebook now has 850
million active users worldwide, with 50 per
cent using it daily.6 Twitter has 175 million
registered users, although it is not known
how many use it regularly to communicate.7
There are concerns for healthcare
professionals about anonymity and control
over what is posted. Anonymity should not
be a concern, as patients do not need to
use their real names unless they want to.
Moderation over what is posted is more
of a problem and someone has to have
responsibility to check posts regularly and
remove anything that is rude or offensive.
What happens when someone posts
negative comments such as a recent bad
experience? This is something that our
trust is grappling with as we try to
www.trendsinurology.com
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persuade them to offer these services.
However, patients can post these
sentiments on personal blogs and websites
outside of our control, so these obstacles
should not prevent doctors/practices
from offering these novel methods of
communication. Many trusts (not ours)
already offer Facebook and/or Twitter
messaging, and NHS Choices regularly
tweets on general health-related issues.8
CONCLUSION
In our survey, only two-thirds of GP
practices had a website. Interestingly,
the same proportion of hospitals had
urology web pages. However, GP sites
were generally more comprehensive
than urology ones. Worryingly for GPs,
only 18 per cent of our patients had
visited their GP’s website. GPs therefore
need to develop their sites further to offer
content that their patients would access.
www.trendsinurology.com
It would be interesting to audit patients
attending GP surgeries to obtain their
views on what services they would like
from a website. Increasingly, patients
will expect information to be delivered in
this way. All doctors should look at their
practice, whether GP or hospital based,
and review whether their information
for patients is up to date and as
comprehensive as possible. Practices
and departments should consider novel
ways of communicating through social
media. Ultimately, we feel that websites
should allow patients to log in to the site
to access their results and correspondence
in a similar way to internet banking.
Declaration of interests: none declared.
REFERENCES
1. International Telecommunications Union
World Telecommunications/ ICT Indicators
Database. The world in 2010. www.itu.int/
ITU-D/ict/material/FactsFigures2010.pdf
2. Office for National Statistics. Statistical
bulletin. Internet access 2010. Households
and individuals. www.ons.gov.uk/ons/rel/
rdit2/ internet-access—-households-and-
individuals/2010/index.html
3. Office for National Statistics. Statistical
bulletin. Internet access – households and
individuals, 2011. www.ons.gov.uk/ons/
dcp171778_227158.pdf
4. NHS Choices. http://www.nhs.uk/Pages/
HomePage.aspx
5. Garthwaite M, Bultitude MF. Urology NHS
webpages: a review of NHS Trusts in
England. Br J Med Surg Urol 2011;4:182–6.
6. Facebook Newsroom. http://www.facebook.
com/press/info.php?statistics
7. Business Insider. http://www.businessinsider.
com/chart-of-the-day-how-many-users-
does-twitter-really-have-2011-3
8. NHS Choices. http://twitter.com/nhschoices
TRENDS IN UROLOGY & MEN’S HEALTH MARCH/APRIL 2012