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  • Over half of acute trusts are now using GP e-Referral Service

    Over half of acute trusts are now using GP e-Referral Service

    Thursday, 14 June 2018 14:29
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    Monday, 04 June 2018 09:58
  • NHS launches National Data Opt-Out facility

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  • ePACT to be decommissioned on June 8 as ePACT2 takes over

    ePACT to be decommissioned on June 8 as ePACT2 takes over

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  • NHS England announces Local Health and Care Record Exemplars

    NHS England announces Local Health and Care Record Exemplars

    Thursday, 24 May 2018 15:52

a computer imageNovember 24 2017

A qualitative study has found that GPs offering patients an electronic consultation service often required additional follow ups and further GP consultations.

E-consultations were seen to have some benefits as consultations could be completed without direct contact between the patient and the GP, and patients liked them. However, “most e-consultations resulted in GPs needing to follow up with a telephone or face-to-face appointment because the e-consultation did not contain sufficient information to inform clinical decision making.” Take up of the service was also deemed to be low.

GPs, practice staff and patients at 36 GP practices were interviewed about the e-consultation system, which operated for 15 months during 2015 and 2016. Responses indicated that there was a perception the system had added to workload. It was also thought the system had provided some patients with an alternative route into the appointment system.

Among the findings were that:

  • 38% of e-consultations resulted in a face-to-face consultation;
  • 32% resulted in a telephone call from a GP for more information to reach a clinical decision;
  • there was an average of two e-consultations a month for every 1,000 patients.

“The experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for clinicians to consult with patients and did not justify their financial investment in the system,” concluded the University of Bristol researchers. “The study also highlights the challenges of remote consultations, which lack the facility for real time interactions.”

The NHS National Institute for Health Research, which funded the research, noted that “online GP consultation systems may not be the answer to reducing GP workload.”

Dr Jeremy Horwood, of NIHR CLAHRC West and University of Bristol's Centre for Academic Primary Care, said: “While our study focused on a particular system in a regional GP consortium, there are lessons here for any GP practice considering moving to an electronic consultation system. There is a central government drive to move to these systems. However, our research shows that they need to be carefully implemented and effectively marketed to yield the benefits that politicians are hoping for.

“Online consultations may have value for some patients, such as straightforward medical enquiries, but they cannot replace face-to-face consultations in situations which are more complex.”

Commenting on the findings, RCGP Chair Professor Helen Stokes-Lampard said that “if used effectively, technology can be hugely beneficial”. However, “new innovations must be implemented in the best interests of patients as a whole – and in ways that alleviate pressures across the NHS, not potentially add to them. It's a myth to say that because we are making greater use of technology that we must be saving resources,” she said.

“This study shows that many of our patients still want to see a GP face-to-face after going online, or to call their local practice to speak to someone about their symptoms. This is not reducing GP workload, or even effectively triaging patients.

“Online consultations, via a smartphone or otherwise, can be great for some patients, but they won't be suitable for others – and they don't necessarily reduce workload for GPs. If practices do choose to offer them, then it should be using approaches known to be safe and secure and be provided in addition to traditional services, not instead of them.”

Earlier this month, the ‘GP at Hand’ app was launched allowing patients registered with a west London general practice to have NHS consultations via smartphone.

Links:
University of Bristol announcement        
J Banks et al. Use of an electronic consultation system in primary care: a qualitative interview study. Br J Gen Pract. November 6 2017; bjgp17X693509.                  
NIHR statement                  
RCGP comment                 
Today’s GP coverage of ‘GP at Hand’ app launch

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