Before deciding on using emails as an alternative to a face-to-face consultation then you may wish to think about:
- What exactly are you trying to achieve through using an alternative to a face-to-face consultation?
- Are you going to use a secure email system such as NHS mail, or a standard email system?
- How will you ensure data security and confidentiality?
- How will you record consultations in the notes?
- Will email consultations be available to all your patients? How will you let them know?
- Do you have clear agreed processes, agreed and understood by all staff?
- What sort of problems do you plan to use email for, and how will you ensure patients use the system in this way?
Before introducing email as an alternative to a face to face consultation then you may wish to think about the following:
The choice of type of an alternative to a face-to-face consultation is dependent on your rationale for using an alternative to a face-to-face consultation. Is it for convenience for patients, improved patient access or to manage demand? It is also dependent on ensuring that the alternative to a face-to-face consultation(s) you have decided to introduce are suitable for your practice and its demographics. More information on who it is for and why can be found here.
Practice set-up
- What will be the initial financial outlay?
- Do you have sufficient infrastructure?
- Will any additional calls be costed? (To call patients to discuss further or where the link has been lost)
- Is this commercially driven? – Will you be using a commercial product?
- Will you be using a standard email system or a bespoke secure system designed for health care such as NHS mail?
- How will you record details of email consultations in the patients’ medical records?
- Have all clinicians in the practice agreed to work in the same way?
- Are there written protocols for both clinicians and administrative and reception staff?
- Will the introduction require further staff training?
- What will you do if the technology fails? – Produce detailed protocols for use
- Will you require funding to inform patients of the changes?
- What sort of consultations do you intend to manage by email and which should not be?
Patient related
- Are there certain patient groups that will be disadvantaged? More information on who it is for can be found here.
- Are you going to make email consulting available to all patients or just some? On what basis will you decide, and is this discriminatory?
- How will you inform patients of the changes? – Possible options are; letters to patients, your practice website, flyers, banners in the practice, social media or word of mouth.
- What do your patients feel about consulting by email? – Speaking to local representatives is key such as a patient participation group.
- Is it more convenient for the patient?
Benefits and Concerns
- Are you anticipating that an email will be shorter/quicker than a face to face consultation? – will you monitor this?
- What might be lost? – Accurate history, non-verbal cues, patient/doctor relationship
- What might be gained? – Flexible working, more control over own workload, patients feeling more relaxed, further continuity of care, accessing patients who are otherwise unable to attend the practice.
- How will you ensure that this does not become additional or hidden work? – Ensure scheduling and recording of the alternative to a face-to-face consultation.
Safety and Security
- How will you ensure the security of email conversations?
- How do you know the identity of the person you are communicating with, or who else might see you email?
- Have you considered how you will ensure that patient confidentiality is maintained?
- How will you ensure security of the patients’ details?
- Are you using a secure system – such as NHSmail?
We have provided some useful guidance below:
- NHSmail: a secure email service approved by the Department of Health for sharing patient identifiable and sensitive information
- Academy of Medical Royal Colleges – i-care: Information, Communication and Technology in the NHS
- Academy of Medical Royal Colleges – Ehealth Competency Framework
- GMC guidance on – Prescribing Guidance: Remote Prescribing via Telephone, Video-link or Online
- Email Consultations in Healthcare
- Health and Social Care Information Centre
- Medical Protection – Risk alert: Technology in general practice
- RCGP – Health Informatics Group
A list of companies that offer support for telephone consultations can be found here:
There’s quite a drive, patients very often expect to be able to email us, they want to email us and we like to try and go with the times and reflect what our patients want, so that’s part of a driver for it.
“Well, I feel that you can express yourself better, I think, for me, message, writing it down, you know, typing it. I just feel sometimes if you are, like, if I’m really not feeling good I can’t really express it.”