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Independents' Day

GP calls off recruitment attempts after introducing e-consultations

A single-handed GP with almost 5,000 patients has called off her recruitment attempts after introducing an email triage system and adding non-GP team members.

Dr Sue Arnott, in Lanarkshire, Scotland, was faced with the retirement of two full-time equivalent partners in the space of 18 months and had no candidates when she advertised for their replacement.

After eight months of struggling to manage demand on her own with no hope of recruiting new GPs, she signed up to the askMyGP consultation service. 

It has proven so popular at the Burnbrae Medical Practice in Shotts over the past year that 60-70% of patients now use the online triage and consultation service, and the practice is even accepting new patients.

Patients can still call the practice but the receptionist fills in the same online form so everyone goes through the same system of triage.

With a multidisciplinary team of advanced nurse practitioner, advanced practice physiotherapist, mental health worker and nurses skilled in long-term management, Dr Arnott says the need to recruit another GP has 'disappeared entirely'.

She said: ‘The difference is huge. I’m managing almost 5,000 patients as a single-handed GP but we have built a team in the practice.

‘My role has changed completely and I’m now seeing more patients with more complex illnesses and chronic conditions.

‘It has completely changed the way we work.’

BMA figures suggest one in four practices in Scotland are struggling to recruit.

Three other practices in Scotland have signed up to the askMyGP consultation system.

Meanwhile, the new Scottish contract brought in from April is indented to put GPs in charge of multi-disciplinary practice teams, leaving them to focus on more complex issues.

For example, half of GP surgeries in Scotland now have access to a pharmacist or a pharmacy technician.

Dr Arnott said her day is now split by 70% online consultations and 30% face to face, but when she does see patients she can spend 20 minutes or more with them.

She said: ‘The need for other GPs has gone, we are coping quite well and patients can always see me when they need to.

‘The only downside is trying to find locum cover for me to do other things or for annual leave.’

She added that feedback from patients has been very positive but they have done a lot of work to manage patient expectation.

‘We went from failing to meet demand to now meeting that demand. It has taken the pressure off massively and often patients only want advice or reassurance.'

However, the positive account comes as the BMA has warned that some practices could 'go under' if inundated with e-consultations.

Dr Andrew Buist, chair of the BMA Scotland GP committee said it was very impressive that Dr Arnott had managed to keep the practice going as the only GP but 5,000 patients was a large responsibility for a single partner.

‘I would imagine it is also very difficult to get locum cover because of that.'

He added that the option of online consultation was only one part of a range of measures that could help to reduce GP pressures.

‘The general feeling is that it has a place. But if I think about my own practice, it would only be appropriate for some patients, probably less than 20%.’

The RCGP has warned that GP practices will require funding to be able to implement digital-first consultation strategies, with many practices facing a lack of basic infrastructure such as fast broadband.

In England, the Government is planning to negotiate changes to the GP contract for 2019/20 to boost 'digital-first' models.

Readers' comments (11)

  • David Banner

    "The only downside is trying to FUND locum cover...."
    Is this a typo? Surely it should be FIND. This poor GP may be facing zero annual leave and burn out, or risk breaching her contract.
    An admirable story, and pleased they have found a way out of the crisis, but you can't help worrying about the possibly indefensible complaints arising from e-consults that will surely start creeping in. I suspect her defence fees will rocket too.

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  • Thanks for pointing this out - it has been corrected

  • The difficulty is when the inexperienced practitioner gives amoxicillin for a PE.

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  • Neil Bhatia

    What's the difference between askMyGP and other e-consultation platforms (such as E-Consult)?

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  • ‘My role has changed completely and I’m now seeing more patients with more complex illnesses and chronic conditions.
    What she does not realise is a simple cough can be a PE and her clinical risks has increased so much "Gross Negligence Manslaughter" charges are just round the corner for her. The GMC will say not best practice, no examination and pursue her till the end.

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  • Never fancied the life of a call centre operative

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  • @neil bhatia

    As far as I'm aware askmygp is a telephone first system. So the gp rings up all patients for the day and tries to deal with the patient over the phone rather than face to face.

    From what I've looked up in the past, they have mixed outcomes. Reduction in workload depends on the surgery itself and the population it's serving.

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  • Spending more time on more complex patients is fine until th BIG downside of no locum cover for annual leave or other activities.Resilience must be much better than mine however to have survived so long so best of luck

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  • can someone explain why face to face should take longer than telephone...I have never understood this (unless of course we do stuff face to face that isn't really needed - like examining them and taking a proper history....)

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  • Just to clarify askmyGP is quite different to eConsult in that it’s not algorithm based - more a new means of contacting the surgery. (So hopefully no amoxicillin for PEs)

    It works as part of a fundemental change to the Practice access model through triaging 100% of patient contacts. askmyGP allows patients to initiate contact with Surgery through a secure web portal (though patients can still call if they want). It means that patients who don’t need (or want) a GP appointment can be managed remotely and frees up face to face appts to the extent that if an appointment is needed it can be offered that day

    This is only possible and sustainable by fully understanding total patient demand and matching clinical supply to it. When this is achieved it works really well.

    We’ve been going with it for the past 12 months and patients and GPs prefer it. A big concern amongst GPs was that this would unleash endless demand for making access easier - this categorically has not happened. Suprising but true

    We also found that since implementing this change that additional staff no longer needed.

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  • (It’s also interesting how quick the people posting have been to discount askmyGP without fully understanding what it is)

    @truth finder - I can’t honestly believe that you are advocating that every patient who has a cough requires a medical assessment for fear that they may have a PE - this would fly in the face of everything that we are trying to educate patients about with regards to self care for minor illnesses

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  • I have been using askmyGP for over 6 months. We now have same day access - with lots of empty slots EVERYDAY. I do home visits within 15min of the request being made; and emergency patients are seen instantly. My locum costs have collapsed. Its an incredibly safe system. And its completely different from its competitors which are years behind. Its not all milk and honey though. We still work hard. But we have results and smiles now instead of tears.

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