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GP appointment booking guidance

Published

Context

GP surgeries that enable direct appointment booking (via “Check for available GP appointments”) in the NHS App can also provide guidance to help patients choose the right appointment.

The guidance is written by the surgery in their internal system and then shown to users in an expander component at the top of the ‘Book a GP appointment’ page. There are no restrictions on what surgeries can write. As a result, the quality of the content and how much it helps someone trying to book an appointment can vary greatly.

The problem

The ‘Book a GP appointment’ page, which previously displayed the booking guidance and allowed users to filter, browse, and select appointments, was removed as part of wider updates to the booking journey which improved its usability and accessibility.

Instead of carrying out most actions on a single page, the updates separated interactions across multiple, simpler steps, ultimately changing the user journey into a form. Research showed this approach was clearer and more usable for patients.

Because of these changes, a new location for the appointment booking guidance which worked with new the form-style journey was needed, while preserving its key benefits:

  • Presenting it before the filtering and selecting interactions, so the user is primed with the guidance before booking an appointment
  • Ensuring it was accessible whilst users applied filters and made selections, so users could refer to the guidance if they got stuck
Two screenshots showing the old appiontment booking guidance on the 'Book a GP appointment' screen

Research

Based on our previous user research into the appointment booking journey, we identified two user needs specific to this part of the app:

  • As a user, I need to be able to refer to booking guidance from my GP, so that I can book the correct appointment and receive the right care for me.
  • As a user, I need booking guidance from my GP to be clear and understandable when booking an appointment via the NHS App, so I know which appointment is right for me.

We didn’t have the scope to address how GPs write appointment booking guidance for this piece of work, so we set some research objectives to meet the first user need:

  • Explore how the placement of GP booking guidance impacts users’ ability to book an appropriate appointment on the NHS App with confidence
  • Investigate whether content in association with the booking guidance (subheadings, expander labels, etc) could be improved
  • Define a location for GP booking guidance in the updated appointment booking journey

User testing round 1: Unmoderated testing

We conducted a round of unmoderated user testing, where three different ways to show the appointment booking guidance was tested across three studies. Participants would only take part in one study.

To gather useful insights about how users interact with the booking guidance, we had to design the tasks and prototype in a way that actively encouraged them to read it:

In the live service, users can book appointments without reading the guidance, even if they aren’t eligible for one, or their choice doesn’t match what the GP recommends. If we had set up the test tasks in the same way, participants would simply follow the instructions we gave them and succeed without needing to read the guidance at all.

To avoid this, we deliberately worded the tasks so that some essential details were missing. Those details were instead placed in the booking guidance for each study. This meant that participants who read the guidance were more likely to complete the task with ease. By structuring the studies in this way, we were able to better observe how users engage with the guidance, particularly when they got stuck or needed more information to move forward.

For example, the task would read:

Imagine you have been invited to book a blood test appointment at your GP surgery as soon as possible. Please show how you would do this in the NHS App.

However, the booking form requires users to select a location and a clinician, along with the appointment type (blood test) given to them in the task. If the participants didn’t select the right location and clinician, their journey would return no appointment results, making it harder for them to complete the task. To know which location and clinical to select, users would have to reference the booking guidance we included in the prototype, which read:

Blood tests are INVITE ONLY and should be booked with Nurse Donna at the Southbank Practice. Also book with Donna for warfarin clinic and B12 injections. Please remember to cancel your appointment if it is no longer needed. Thanks

The booking guidance used was based on a real-world example. It’s important to note, that in the actual booking journey you cannot select answers that would amount to no appointment results. This functionality was manufactured for this study specifically to test how users interact with the booking guidance when they get stuck.
The tasks for each study were the same, but the way we presented them with the GP appointment booking guidance differed.

Study A

For study A, we displayed the guidance in full on the start page of the journey only

A series of screenshots showing what was tested in study a

Study B

For study B, the start page was removes and the guidance was displayed to users with an expander component below the H1 on the first four steps in the booking form

A series of screenshots showing what was tested in study b

Study C

For study c, the guidance was shown in full on the start page and within a details component below the H1 on the first four steps of the booking form

A series of screenshots showing what was tested in study c

User testing round 2: Moderated testing

We tested a refined version of the booking guidance design as part of a round of accessibility testing where some other improvements to the journey were also being tested. In this iteration, we tested two more versions: the guidance being displayed on the start page in full and the guidance contained within a details component on the first four steps in the form, just above the primary ‘continue’ button, rather than below the H1.

The aim of this was to create a more logical order of elements for those who use screen readers.

A series of screenshots showing what was tested in moderated usability testing

Testing results and findings

In the unmoderated studies where the guidance was shown to users in full on the start page 59% of users actively read it. Of those users, 53% of them made an effort to follow the guidance when booking their appointment.

However, some users found the guidance confusing, thinking it had been written by the NHS App or that it was telling them to go book their appointment elsewhere. This was shown in both the moderated and unmoderated studies.

In the unmoderated studies B and C, when users were progressing through the first few steps in the form, only 5% of users opened the guidance. However, of these users, 100% of them found it useful and applied the guidance, enabling them to successfully book their appointment when they got stuck.
There was no significant difference in the utility of the booking guidance between locating it higher or lower on the page, or whether it was within an expander or a details component.

Across all studies, we tested two variations of content:

  • ‘Appointment booking guidance from your GP’
  • ‘Booking guidance: help from your GP’

Across all studies, these didn’t test well with users, who many thought that this was still written by the NHS App.

One flaw in the unmoderated studies was that many participants who were stuck were able to get around the challenge by selecting the ‘I have no preference’ option on some of the steps in the form, avoiding the need to check the guidance to make a successful booking, making the testing slightly less effective. In the moderated testing (round 2), the ‘I have no preference’ option was removed. Naturally, more users referenced the guidance, but comparisons between the two rounds of testing in this regard are tricky to make given the numbers and type of user testing.

Final design

Start page

We decided to show the guidance on the start page within a details component labelled: ‘Tips from your GP on how to book an appointment.

Given our research showed that displaying guidance in full on the start page can confuse users, and that we know some GP guidance can be very lengthy, poorly written and irrelevant, we opted to show the guidance on the start page within a details component. This way, users who need to access this information can do so easily whilst maintaining a more consistent experience for all userss given we can’t control the content within. The relabelling makes it clearer that the content is from your GP.

Within the form

We decided to show the guidance on the first four steps of the journey within a details component located just above the primary ‘continue’ button. This position makes the most logical sense for screen readers and, through testing, the position of the component on the page showed no significant usability differences.

The only exception to this is on the slot selection screen, where we positioned the tips nearer the top of the page so they interfere less with the ‘Load more’ pattern at the bottom of the page. Whilst very few users in testing interacted with the component after the start page, knowing that the guidance can include information pertaining to appointment type, location, healthcare professional and slot, it makes sense to allow the users to easily reference the information at these steps.

Screenshots of the final design

Next steps

Whilst we have optimised the position of the appointment booking guidance in the uplifted appointment booking journey, this work does not address the observations we have made to the quality of written guidance provided by the GP surgeries for patients. In future, we plan to understand more about how we could encourage better guidance to be written.