Key messages
- a city-wide digital inclusion programme delivered through voluntary and community sector organisations improved use of digital health services
- partnership working with local voluntary organisations was central to engagement
- place-based delivery helped reach residents facing digital exclusion
- digital inclusion support extended beyond skills to include confidence and trust
- findings suggest that local context shapes the effectiveness of digital interventions.
Policy implications
- digital inclusion strategies should be delivered through trusted community organisations
- place-based approaches may be more effective than generic national programmes
- integration between health services and voluntary sector partners can support equitable digital access
- future programmes should build evaluation into design from the outset.
Gaps
- lack of controlled study design limits causal inference
- limited analysis by age, ethnicity or deprivation
- uncertainty about which population groups benefit most
- need for longer-term follow-up on health outcomes.
Commentary
This study provides evidence that community-led digital inclusion initiatives can improve engagement with digital health services. By working through voluntary and community sector organisations, the programme was able to reach residents who might otherwise remain excluded from digital care.
Considering care equity, the findings reinforce the importance of place-based delivery. Digital exclusion is shaped by local factors, including trust, social networks and access to support, which community organisations are often well placed to address.
The emphasis on partnership working highlights that digital inclusion is not solely a technical challenge. Social relationships and local infrastructure play a key role in enabling people to engage with digital health services.
However, the study also highlights evidence gaps. Without controlled designs and analysis, it remains unclear which groups benefit most and whether digital inclusion reduces or widens inequalities. Strengthening evaluation methods will be important to guide future use of technology in care.
Key messages
- digital access routes such as e-consultations and online triage often replicate or worsen existing access barriers
- limited access to devices, data and reliable internet inhibits use of digital primary care
- lack of language support and English-only digital interfaces reduce accessibility
- digital systems are frequently poorly aligned with users’ needs and circumstances
- GP staff often rely on informal, ad-hoc workarounds to support patients excluded by digital systems.
Policy implications
- digital-by-default approaches risk widening inequalities if alternative access routes are not protected
- primary care digital systems should be designed with language support and accessibility in mind
- investment in digital inclusion alone may be insufficient without service design changes
- practices may need clear guidance and resources to support equitable access rather than relying on informal workarounds.
Gaps
- limited evidence on long-term impacts of digital-by-default models on health outcomes
- lack of quantitative assessment of exclusion at population level
- limited evaluation of which design changes most effectively reduce digital barriers.
Commentary
This study highlights how the use of technology in care can deepen inequalities when digital systems become the default route for access. For adults from minoritised ethnic communities, barriers linked to device access, data affordability and language support intersect with existing structural disadvantages.
The findings challenge assumptions that digital access is inherently efficient or inclusive. Where systems are designed without consideration of lived experience, technology can displace barriers rather than remove them. From an equity perspective, this raises concerns about who digital transformation is designed for and who it leaves behind.
The reliance on informal staff workarounds illustrates the strain placed on frontline services. While these adaptations may help individual patients, they are inconsistent and fragile, masking systemic exclusion rather than addressing it.
Overall, the study highlights that the use of technology in care must be accompanied by inclusive design, meaningful alternatives and organisational support. Without this, digital-by-default models risk reinforcing inequities in access to primary care rather than reducing them.
Key statistics
- the study is based on interviews with 100 adults from minoritised ethnic communities across four UK locations
- 20% of participants were aged over 65 and 60% were female
- participants represented a range of ethnic groups including Bangladeshi (23%), Black African (21%), Pakistani (17%), Indian (13%), Black Caribbean (12%) and Chinese (9%)
- participants reported wide variation in digital access, from high competency to complete non-use of the internet
Key messages
- digitalisation of primary care can replicate and worsen existing barriers for minoritised ethnic communities
- digital exclusion is driven by limited access to devices, poor internet connectivity and low digital literacy
- language barriers remain a major obstacle, with most GP platforms only available in English
- some GP staff lack cultural competence and resources to effectively support ethnically diverse populations
- reliance on informal interpreters reduces privacy and can delay access to care
- women in multi-generational households often carry a disproportionate burden managing digital access to care
- over-reliance on digital tools and limitations in clinical training on different skin tones can contribute to misdiagnosis or delayed treatment
- concerns about data privacy and confidentiality can deter engagement with digital GP services
Policy implications
- develop inclusive digital primary care systems that account for digital access, literacy and device limitations
- embed language support and translation options within GP platforms and services
- provide training for health professionals on cultural competence and anti-racist practice
- maintain non-digital access routes to avoid excluding people unable to use online systems
- design digital services with input from minoritised ethnic communities to reflect real needs
- improve data governance transparency to build trust in digital health systems
Gaps
- the study focuses on qualitative experiences and does not quantify the scale of exclusion across the wider population
- limited exploration of how digital exclusion varies across different regions beyond the selected case sites
- does not examine long-term health outcomes associated with digital exclusion
- limited focus on how policy changes could be implemented in practice across the NHS
- further research is needed on how digital solutions can reduce rather than reinforce inequities
Commentary
This study explores how the move towards digital GP services is affecting people from minoritised ethnic communities in the UK. It shows that while digital systems are intended to improve access, they can create new barriers for people who already face disadvantages.
Many participants described what the authors call “digital precarity”. This includes not having reliable internet, lacking suitable devices, or not having the skills to use online systems. For some people living on low incomes or in temporary housing, even downloading GP apps or maintaining mobile data was difficult.
Language is another major issue. Most GP apps and online systems are only available in English, which makes it difficult for people who are not confident in reading or writing English. Some rely on family members or friends to help, which can reduce privacy and delay care.
The study also highlights how care responsibilities are unevenly distributed. Women in multi-generational households often manage multiple GP accounts for children, parents and relatives. This creates additional pressure and can slow down access to services.
There are also concerns about how digital systems are used in clinical care. Some participants reported that sending photos or describing symptoms online did not work well for people with darker skin tones. This reflects wider gaps in clinical training and risks delaying diagnosis or treatment.
From a health and social care equity perspective, the findings show how digital transformation can widen existing inequities if systems are not designed inclusively. People who face barriers related to income, language, ethnicity or housing are more likely to be excluded from digital services.
Overall, the study highlights that improving access is not only about introducing new technology. It requires designing services around the needs of different groups, maintaining alternative access routes, and addressing structural inequities that affect how people engage with care.