Online GP consultation systems need further development and careful implementation to realise benefits
Policymakers are advocating technological alternatives to face-to-face GP consultations to reduce GP workload and patient waiting times. This research evaluated an online consultation system and found that it did not reduce GP workload, but could improve access for some patients. Online consultation systems could be improved by changing the way they are marketed to patients and used.
About the research
General practice clinical workloads and patient appointment waiting times are increasing. One possible solution, that NHS England is investing £45 million on implementing, is online consultation systems for GP practices. Online consultation systems aim to improve patient access to health advice and reduce use of face-to-face GP appointments. One system, eConsult, is a web based platform that sits on a GP practice website and enables patients to submit their symptoms to a GP online (called an e-consultation). The system also provides online self-help and pharmacy advice for over 100 common conditions seen by GPs.
NIHR CLAHRC West evaluated eConsult in primary care practices across Bristol, South Gloucestershire and North Somerset. The evaluation was a collaboration with OneCare, a general practice consortium which facilitated a pilot of eConsult in 36 practices between April 2015 and June 2016. The evaluation used:
- Website statistics which showed the level of use over 15 months for 36 practices along with survey data completed by patients who had used the system.
- Data from eight GP practices which showed what actions were taken by the practice following an e-consultation.
- In depth interviews with a range of staff in six practices.
- Practices should promote the use of e-consultations for straight forward or continuous conditions. They are not suitable for conditions which are new, complex or urgent where face-to-face consultations are needed.
- System developers should ensure that the systems can enable patients with existing or straightforward clinical queries to use e-consultations but those with new or more complex issues are directed to a face-to-face or phone consultation. This will reduce duplication of GP workload.
- Developers and practices need to consider how online consultation systems are designed, promoted and marketed to patients. The systems will work more effectively if patients understand what types of issue are suitable for e-consultations.
- Developers of e-consultation systems need to improve technological compatibility with GP practice IT systems to increase efficiency and ensure patients receive prompt communication from the practice following an e-consultation.
- NHS England needs to develop clear guidance for practices on how best to use and implement online consultation systems so they meet desired aims of both improved patient access and practice workload efficiencies.
- While the system did save some patients having to see their GP, clinicians needed to make direct contact (telephone or face-to-face) with patients in 70% of e-consultations which often duplicated GP workload.
- A face-to-face consultation was more likely for patients presenting with a new condition compared to a pre-existing condition.
- Efficiencies were possible when e-consultations could be completed without direct clinician-patient contact. These were more likely to be around repeat prescription, fit note, test results or follow up advice for ongoing conditions and treatment.
- Use of e-consultations was very low. On average a practice received 18 e-consultations per month.
- A minority (14%) of patients used the system to access self-help and signposting information.
- Patients submitted most e-consultations on weekdays and during GP practice opening hours. Self-help advice was more likely to be accessed in the evening. Saturday was the least popular day to use the service.
- Patient satisfaction of the e-consultation system was high. However, 14% of patients had not received a response to their e-consultation after 7 days.
- The use of e-consultations during the pilot was not at levels to make the system financially sustainable. Practices chose not to financially invest in the system following the pilot as they did not consider that the current system produced sufficient savings in GP contact time.
Banks, J. Farr, M. Northstone, K. Bernard, E. Salisbury, C. Edwards, H. Horwood J. (2017) The use of electronic consultation in primary care: views and experiences from general practice. British Journal of General Practice.
Edwards HB, Marques E, Hollingsworth W, Horwood J, Farr M, Bernard E, Salisbury C, Northstone K.
(in press) Use of a primary care online consultation system: evaluation of a pilot. BMJ Open.
The research is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. For more information on NIHR CLAHRC West, please see www.clahrc-west.nihr.ac.uk/ or follow @CLAHRC_West
One Care Consortium was a collaboration funded by the GP Access Fund to support the development of a strong, resilient and effective primary care sector in Bristol, North Somerset and South Gloucestershire. The collaboration has since re-constituted as One Care (BNSSG) Ltd. For more information on One Care,
please see www.onecare.org.uk or follow @onecaretweets
Policy Briefing 52: November 2017
Contact the researchers
Dr Jeremy Horwood, Senior Research Fellow, NIHR CLAHRC West / Centre for Academic Primary Care,
Bristol Medical School, University of Bristol. J.Horwood@bristol.ac.uk
Michelle Farr, Jon Banks, Kate Northstone, Hannah Edwards, Elsa Marques, William Hollingworth,
Chris Salisbury, Jeremy Horwood
National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West
(NIHR CLAHRC West) / Centre for Academic Primary Care, Bristol Medical School, University of Bristol.