7 November 2017
Online GP consultation systems as they currently stand are unlikely to take the pressure off GPs and practices, despite NHS England’s drive to promote them through a £45 million fund. NIHR-funded researchers at the University of Bristol found that managing GP consultations in this way can in fact increase workload for GPs and practice staff. But the researchers also emphasise that, with careful refinement and implementation, these ‘e-consultations’ have the potential to improve patient access and general practice efficiency.
The study found that most e-consultations resulted in face-to-face or telephone consultations, because GPs needed more information and to ask the patient questions. This meant that GPs first assessed the e-consultation, and then assessed the patient on the phone or during a face-to-face appointment. Practice staff felt they were doubling up on their workload.
The researchers did 23 in-depth interviews with GPs and practice staff at six practices piloting the eConsult system in the West of England. This was part of a wider evaluation that measured how much the system was being used and what happened to patients after they had submitted their online consultations.
The research found issues with the system which meant it didn’t fulfil its key aim of freeing up and enabling GPs to manage their time. The e-consultation platform did not fit seamlessly into the practices’ IT systems and required information to be manually added to a patient’s electronic medical record, creating extra workload for administrative staff.
Staff felt the system worked well for straightforward queries around prescriptions, fit notes and follow-up from previous consultations – enquiries which did not require direct patient-GP contact. GPs could respond to these by giving a message to the admin team to relay to the patient, thereby finishing the e-consultation. Conversely, when patients had multiple symptoms, or had conditions which were new and complex, GPs often needed to see or speak to the patient.
Some staff felt that patients were using the online system to secure a face-to-face or phone appointment. Staff suggested that the online system would be of more value if it filtered patient enquiries so that straightforward clinical issues could be directed through the online system, but for more complex medical issues, patients would be advised to contact the practice to secure a face-to-face or phone appointment.
Jon Banks from the research team at NIHR CLAHRC West said:
“Online consultations have been promoted and supported by NHS England and the Prime Minister’s Challenge fund. Our research highlights both their potential and their limitations. The practices involved in the research were all keen to adopt and engage with new technologies that can help them and their patients, but the system in its current form needs refining. It works for the more straightforward types of enquiry but it needs to filter out or redirect patients with more complex issues so that they can be seen face-to-face or over the phone.
“The system would also benefit from greater integration with GP practice IT systems as it generated extra work for the admin team moving the e-consultation into the patient’s record.”
The research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) and the One Care GP consortium who were piloting the e-consultation system.
‘Use of an electronic consultation system in primary care: a qualitative interview study‘ Jon Banks, Michelle Farr, Chris Salisbury, Elly Bernard, Kate Northstone, Hannah Edwards and Jeremy Horwood. Published in the British Journal of General Practice (BJGP)