From red tape to green: admin that works for everyone

NHS England and the government have launched a new ‘red tape challenge’. Their ambition is to make form-filling by GPs more efficient so they can free up time to see patients.

But it’s not just GPs who want efficient admin – patients do too. We know that people can struggle to book an appointment or get their test results, and that managing the admin associated with your health can feel like a full-time job. Indeed, the Prime Minister was right to highlight that it is not acceptable for patients to receive an appointment letter that arrives after the appointment.

The way the NHS communicates with patients matters. Poor admin can restrict people’s access to care, negatively affect their wellbeing, and undermine trust in the NHS. It can also have a negative impact on staff. Patients who have to move between primary and secondary care (and back again), or have multiple long-term conditions can experience the highest burden when admin is not co-ordinated or designed around their needs.

Admin staff also bear the weight of failing admin systems. They are the first point of contact for people trying to navigate a complex and often confusing health and care system. Admin staff are left supporting patients when they can’t get through on the phone or when test results are lost. They often bear the brunt of patient frustration, anxiety, fear – and abuse. Admin staff are in a unique position to make a real difference to how people experience the NHS.

So before ripping off the red tape in an attempt to prioritise ‘patients over paperwork’, or assume AI and digital are the only answers, let’s take this opportunity to really understand the impact admin can have on patients. Sustainable solutions won’t be found without including patients’ insights (and feedback from admin staff too) into what does and doesn’t work.

We need an emphasis on better admin – not necessarily less.

We need to reduce waste – not necessarily reduce investment in admin.

What’s required, then, is a different way of thinking about admin; one that recognises the value of good admin and its potential.

Great admin has the potential to improve patient experience, promote inclusion, and create a better working environment for staff. It also builds the trust and confidence patients have in the NHS and shapes their perceptions of waste and efficiency. A good place to start re-thinking what great admin looks like and how to achieve it are the government’s own design principles. The first of which starts with identifying user needs and states clearly that ‘if you don’t know what the user needs are, you won’t build the right thing.’

It helps to see how these principles are applied in practice. I’m always on the hunt for great examples about how to book an appointment and I often use the Covid-19 vaccine booking as a good one. And, although it’s not admin specifically, if you want to see more detail on how to do this work in practice, take a look at how users (including staff and patients) were included in the design of the pre-payment prescription for Hormone Replacement Therapy.

One of the reasons admin doesn’t get the investment and priority it deserves is that it is seen as an area that can be cut. A focus on red tape reinforces a view that admin is not essential for the delivery of high quality care. That’s why I’m drawn to the concept of ‘green tape’ It reminds me that organisations need effective mechanisms to achieve their objectives. Green tape is not simply the opposite of red tape, but involves focusing on the way rules are designed in order to meet your objectives and improve people’s lives.

Historically, red tape signified that a legal document was important. Now, red tape is viewed as something that is unnecessary and burdensome – something to be eliminated or reduced. So, if we’re cutting red tape, then we also need to find ways to roll out that green tape too. Newly installed ministers wanting to address record low public satisfaction with the NHS would do well to focus on admin. Improvements to how patients interact with services, and to overall patient experience will soon follow.