For many GPs, giving out their email address to patients sounds like a foolish move. Quite rightly, they worry about miscommunication, missing vital information and data security.
However, at one time telephone consultations were viewed with similar suspicion, and now they are commonplace. With careful planning, an email consultation service can be a similarly welcome addition to a practice's offering to patients – and can help free up time.
With the Government keen on an ‘information revolution' in the NHS, GPs are going to have to find cost-effective ways to improve the access they give to patients. Our practice has been trialling an email consultation service since 2007 and we have found it to be quick, convenient and a way of offering patients additional ways to access their GP.
Why email consultations?
We are a busy training practice, with four partners and three part-time salaried GPs covering 9,500 patients. As with many practices, we found there was an ever-increasing demand on appointments and GP time, but no prospect of additional capacity.
Towards the end of 2007, we had a team meeting to look at how we could manage this increasing demand and agreed that we needed to offer something different rather than ‘more of the same'.
As email was an increasingly popular method of communication, this was suggested as a possible tool we could use in general practice to do this. Potential advantages were that patients could contact their GP at any time of the day and the GP could respond at a time convenient to them. Also, emails could be kept short and to the point and the correspondence could be easily copied into our clinical system as a record, which would also save time.
What we did
Of course worries were expressed about the possible negative consequences. The GPs were worried that giving out their email addresses to patients would open the gate to a flood of emails. There were also questions about what would happen to these emails if a GP was away on annual leave, and about the issue of security.
We decided to investigate further, and as our website had been recently redesigned, we agreed to look at whether it was possible for patients to access GPs from there. We had already set up a method where patients could make suggestions or complain to our practice manager via this route.
We investigated the idea with our website designer, who confirmed that it would be possible to set up access for patients to GPs via this route without giving out individual GPs' email addresses.
Emails sent via this route could also be directed to a third party at the surgery in case it needed prompt attention. This would cater for times when a GP was away from the surgery on annual leave or for other reasons.
All messages also go to our practice manager, who is able to keep statistics of who has emailed and what they require. She is also able to forward emails on to another GP during her annual leave.
For security, our website designer installed an SSL – a ‘secure socket layer' for that page of our website to encrypt the data sent to us.
How we did it
We advertised the new service via our surgery newsletter, posters, our digital display board in the waiting room and our practice website.
The web page titled ‘Contacting your doctor' was altered to include an email link to those GPs who offered email consultations. The patient is able to select which GP their email goes to via a drop-down box.
It is made clear on the site that email communication is only suitable for non-urgent queries, to ensure that it is not used for potentially urgent clinical situations. Initial emails were directed both to the GP selected and to the practice manager, who could monitor queries according to content, type of query and whether a speedy reply was necessary.
Any emails directed to an absent doctor were then forwarded to a colleague if the reply was deemed semi-urgent.
We ran a ‘buddy' system in the practice so each GP had someone who dealt with matters if they themselves were unavailable. Alternatively, the email was dealt with by the ‘on-call' doctor of that day.
The web form also required patients to fill in several fields to ensure basic facts were available to the relevant GP – the patient's name, date of birth, address, phone number and email address.
The trial ran for three months from September 2007 and involved four GP partners out of seven. During that time, the GPs received 190 emails. It was popular with both patients and GPs and the workload produced was not onerous. Patients using the service were from all age ranges and older patients were very enthusiastic.
Five GPs voted to continue the pilot, with one reluctant to be involved because of medicolegal concerns.
Results
The email service has proved a success with patients who have found it a valuable resource and there have been no complaints about the service.
It has almost certainly reduced the demand for face-to-face consultations and is valued by receptionists as it gives them another suggestion to make when a patient wants to contact their doctor without the need for a face-to-face consultation.
Email communication also frequently benefits patient care; for example, following a consultation patients sometimes email with relevant information they forgot to mention.
Patients are able to inform the GP promptly about reactions to medication and email them about their choices when they decide where they want to be referred to. The service also enables young people to share problems they may be too shy to reveal in a face-to-face consultation.
In 2010, nearly 1,500 email consultations were conducted via the website. Of these, the majority (approximately a quarter) were for prescribing queries, including simple medication review updates and prescription requests.
The next most popular category was for clinical issues, followed by referral queries and then emails requesting the results of investigations. In 2011, to date we have had 611 email consultations (see chart above for full breakdown of queries we have received this year).
One of the initial concerns from the GPs was whether the availability of email access would provide an overwhelming additional workload. While it is difficult to ensure equality of workload (some GPs' patients were more ready to use the service than others), documentation of email correspondence in the patient's notes is done easily by either looking through the emails and inputting the reply, or by logging the consultation under the email category on the EMIS system.
Long and involved emails are discouraged, and the patient is asked to make an appointment if they have any queries that are better dealt with in person, especially when it comes to clinical symptoms such as rashes.
We find GPs like communicating by email. They can deal with queries at a time that is convenient to them and they find it easier to give written rather than verbal instructions. Equally, the patient has a written record of their conversation that they can refer to again, which means there is less chance of misunderstanding.
Dr Sue Ruddock is a GP in Oxfordshire. This article was prepared with the help of practice manager Susan Johnson.
Giving patients email access to their GP Popular email queries
Drugs - 32%
Clinical - 29%
Admin - 19%
Referrals – 10%
Results - 9%
Appointment requests - 1%
Audit of 611 emails to GPs from Jan-April 2011
