Evaluating an online consultation system in GP practices

Project aims

NIHR CLAHRC West, in collaboration with the One Care Consortium, evaluated the effectiveness, acceptability and impact of implementing eConsult, in local GP practices.

What we did

Thirty-six GP practices across Bristol, South Gloucestershire and North Somerset piloted the eConsult platform between April 2015 and June 2016.

Data was collected from:

• website usage statistics
• patient survey data
• health care resource use data from patients’ electronic medical records
• interviews with practice staff (GPs, nurses, practice managers, admin, reception and IT staff)

We summarised the number and types of patients using the online platform, when they accessed it and what they were accessing it for. We also examined the views and experiences of patients and practice staff who used the system.

What we found and what this means

A minority of patients using the system clicked through to self-help and signposting information, while 21 per cent of patients submitted their symptoms to a GP (an e-consultation).

Across the participating practices patient use of the system was low during the pilot. Patients submitted most e-consultations on weekdays and during normal working hours. Most patients said they valued the eConsult system.

Practices were often motivated to use the system because it offered the potential to reduce face-to-face contacts and free up GP time, as well as improving access for patients. However, GPs highlighted the challenges of remote consultations which lack the facility for real time interactions with patients.

While the system did save some patients having to see their GP, the majority of e-consultations resulted in either a face-to-face consultation or a telephone call from a GP.

GPs reported e-consultations worked best for simple and routine enquiries that they could respond to without the need for a face-to-face or telephone follow up.

When symptoms were complex or new, clinicians often felt it was best to arrange a face-to-face consultation. Practice staff felt these cases were using more GP time than if there had just been a usual face-to-face appointment in the first place. Lack of integration between the online consultation system and GPs’ existing IT systems also created challenges which could duplicate staff workload and lead to communication difficulties.

Online consultations were not an immediate solution for efficiency savings, but could improve access for some patients. Improvements are needed to e-consultation platforms to enhance integration with existing IT systems. Better guidance is also needed for patients on how to use the system and for practices on how to implement it.

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