E-consult

Before deciding on introducing an e-consultation service then you may wish to think about:

  • What exactly are you trying to achieve through using an alternative to a face-to-face consultation? 
  • An alternative to a face-to-face consultation is a learning process, it might take time to embed and could develop organically which might include finding more uses than originally expected.
  • Beware that commercial interests are at play and people are selling products which have not necessarily be independently evaluated.
  • How will you make your patients aware of the availability of e-consults?
  • Do you have clear agreed protocols so that all contacts are responded to in a timely manner?
  • How will you record e-consultations in the medical records?

Before introducing an e-consult 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 costs 

  • What will be the initial financial outlay?
  • Do you have sufficient infrastructure?
  • Will any additional calls be costed? (To call patients back)
  • Is this commercially driven? – Will you be using a commercial product?
  • Is this a funded pilot? What will you do once the pilot is finished?
  • Will the introduction require further staff training?
  • Will you require funding to inform patients of the changes?
  • Do you have clear protocols and operating procedures for all staff so that incoming patient requests are dealt with in a reliable and timely manner?

Patient related

  • Are there certain patient groups that will be disadvantaged? More information on who it is for can be found here.
  • How will you inform patients of the changes? – Possible options are; letters to patients, flyers, banners in the practice, social media or word of mouth.
  • What do your patients feel about e-consulting? – Speaking to local representatives is useful, for example via a patient participation group. 

Benefits and Concerns 

  • Are you anticipating that an e-consult will be shorter/quicker than a face to face consultation? – How will you know?
  • The proportion of e-consults that are followed by a face to face or telephone consultation is crucial to understanding the efficiency of the system – you can audit this.
  • What might be lost? – Accurate history, non-verbal cues, patient/doctor relationship
  • What might be gained? – Flexible working, more control over workload, patients feeling more relaxed, further continuity of care, accessing patients who are otherwise unable to attend the practice.
  • What will you do if the technology fails? – Produce detailed protocols for use.
  • How will you include the contents of the consultation in the patient records – Is it an integrated system (recommended where possible), or will it be in a separate attached document?
  • 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.
  • How many patients need to use the system in order for it to be worth the cost and effort? 

Safety and Security 

  • How do you know the identity of the person you are communicating with, or who else might see your communication?
  • Have you considered how you will ensure that patient confidentiality is maintained?
  • Are there conditions that should not be managed by e-consult? Is this clearly recorded and communicated to patients and staff? 

We have provided some useful guidance below:

A list of companies that offer support for telephone consultations can be found here: