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A faulty production line

Online GP consultations don’t save time or money, finds study

Online consultation systems are not likely to have any notable impact on patient waiting times and could even add to practice workload, according to new research.

The research looked at the impact of online consultations in primary care, reviewing a pilot study between April 2015 and June 2016 involving 36 practices using the eConsult (formerly WebGP) platform, which enables patients to self-manage and consult online with their own GP through their practice website.

One of the key findings of the research, published by the Society for Academic Primary Care (SAPC), was that 38% of e-consultations then resulted in a face-to-face consultation and a further 32% in a telephone call from a clinician.

GP practices will be be incentivised to offer ‘online consultations’ to patients through a £45m funding pot as part of a new injection of IT funding announced in NHS England’s General Practice Forward View

The most common reason for an e-consultation was for administrative reasons (for example, requesting fit notes, repeat prescriptions) followed by infections, immunological issues and musculoskeletal issues.

The researchers said: ‘Unless usage of online platforms increases and integration with IT systems improves, online consultation systems are not likely to have any notable impact on patient waiting times and staff workload and may add to practice workload.

‘While our results indicate that there is an appetite amongst patients and practices to engage with digital communication, the study also highlights the challenges of remote consultations which lack the facility for real time interactions.’

BMA GP Committee chair Dr Richard Vautrey said: 'The risk is that online consultations simply add another lane to the motorway leading to the GP practice and don’t replace or reduce the number of consultations. Any electronic communication needs to be handled wisely and with care.’

He added: ‘They can be good for things like repeat prescriptions but they cannot replace face-to-face consultations for complex issues. In a face-to-face situation GPs can pick up visual clues and can get to the bottom of things when a patient presents with one thing but that is not the real health issue.’

Family Doctor Association chair Dr Peter Swinyard said: ‘I am gently cynical about it. It’s hard to do consultations on a computer. Judging from this study, most GPs (70%) ended up having to do two consultations (face-to-face or telephone) as a result.’

Dr Swinyard said that electronic consultations have their place, for repeat prescriptions for example, but ‘if someone says they have a pain in their tummy then I would rather see them’.

Dr Swinyard added: ‘GPs use all their senses, they can "smell illness", the way someone walks in, the way they act on the telephone, these are all non-verbal clues.

‘This is the sort of trendy thing that a Government bereft of ideas would come up with – instant access to a doctor.’

Birmingham-based GP 'superpractice' Modality has moved to having 80% of their patient contact via telephone or online.

A spokesperson told Pulse: ‘From our perspective, it is essential to establish robust IT systems and architecture to make online services comprehensive and integrated.

'The experience that Modality Partnership has of using digital solutions has been positive and we continue to seek innovative ways to support our patients to access primary care services.’

The spokesperson pointed out that a cohort of Modality’s Hull practices are piloting the e-consult system.

‘This only began a couple of months ago so it is too soon to be able to comment on the overall impact, and whilst patients have been using it, we have noticed that largely the queries have been admin-related rather than clinical requests,’ added the spokesperson.

‘We will continue to evaluate the impact and assess if such a system is to be deployed across all of our sites.’

A report from the Nuffield Trust health think-tank last year warned that online services and apps were no ‘magic bullet’.

And in May last year a survey found that very few GPs are offering email or Skype-style consultations and most have no plans to introduce them in the future.

The survey asked more than 400 GP practices about alternatives to face-to-face consultations. Only 6% said they used email consultations regularly – and none at the time offered internet-based video consultations on programmes like Skype or FaceTime.

The online consultation research was presented to the SAPC annual scientific meeting in Warwick this month. It was funded by the One Care Consortium and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust.

An NHS England spokesperson said: 'A number of practices are already running online consultations and have found them to offer both patients and GPs a quicker, more convenient option than face-to-face appointments.

'This is why we have committed £45m over the next three years to give every practice across the country the chance to offer online consultations and we will be announcing more details shortly.’

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Readers' comments (22)

  • neither does triage

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  • we have recently introduced engage consult. we are cautiously optimistic on results so far! It depends on the aim of the system that you use. we do not use our system to reduce face to face consultations, but instead to improve quality of care and safety for clinicians and patients. Patients are contacting the practice as they are concerned and they feel that they need to see a doctor.

    it is not too onerous to read a report before inviting the patient to a consultation with the appropriate team member. It is useful to know what the patient is coming in with and I personally find the initial ICE questions really useful.

    I have also put in a link the conference abstract.

    It will be interesting to see how this develops with time.

    Dr Hannan
    Priory Gardens Surgery

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  • I hope this will be shared with Jeremy Hunt, although I suspect his selective dishonest perception will quietly ignore it.

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  • Just a fast track fot the worried well to make additional demands useful for sick notes but not a lot else. I have grave worries for the quality of care provided by an organisation that can sort 80 percent of issues with half the information. This is not a quality solution.

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  • Well knock me down with a feather ...

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  • This is useful research. It seems however that these days the policy comes first, then we must wait for the research to prove that this new thing does not work, the money has been wasted, and the old method was probably the best.

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  • Healthy Cynic

    Never lose sight of this - if a 'consumer' does not value a service he/she will abuse it.
    GP consultations are free to the punters. I'm cool with that for all manner of reasons. But I still want Joe Blob to have to go through a process - 'do I need to see the GP?', followed by making the effort to book an appointment (online is great for this bit), followed by actually having to travel to the surgery, at an agreed time, and to interact in a kind of humany way with the bloke who's trying to help him.
    OK, I'm guilty too of being one of the 'me,now' generation. By which I mean I order my Chicken Balti on Just Eat and wait for the minimum-wage bloke to deliver it. But I don't think that model fits the non-commercial (and slightly more serious) world of general practice.
    Skype is for speaking to your gap year offspring dowm under, not to further harass Dr Grumpy who's already up to his elbows in the Slough of Despond.

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  • watchdoc | GP Partner/Principal

    Unfortunately its far worse then that.
    Several of the vanguards/mcp across the south of England are pushing ahead with web gp platforms despite the evidence.

    Often middle managers are pushing these projects as it acts as a justification for their own jobs and they use pseudoscience to justify it.

    For example at a recent presentation in the Portsmouth region one manager claimed they had saved 17000 appts based the number of times people had used the system. I asked had the practices been able to cut a session of doctors time - of course they hadn't - they hadn't saved any real time .

    Also the cost of such systems is in the order of 100's of thousands of pounds over a year regionally.

    The opportunity cost of diverting such funding is criminal in my opinion.

    They are good software packages but deal with low level want not high level needs.

    But in pharma we're producing our own versions which then we will sell - and there are plenty of takers with money to burn!

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  • Why would anyone think that adding another way for the patients to consult save time?

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  • Increased access and increased ease of access drives demand - not need - have never seen how this might be helpful

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  • Ivan Benett

    If they provide a more accessible service for patients and they are cost-neutral - that's a good thing - right? And if it save admin time or unnecessary consultations, that's a good thing - right? If they are time neutral and provide a better service, that's good - right? So why the negative headlines?

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  • Ivan Bennett - it will only be 'time neutral' if it is INSTEAD of a face to face surgery - they way these things usually work in practice is that it becomes additional to the already offered appointments (which will always fill up) and therefore additional workload. Will you be happy for this to add on to your 'job plan' as a salaried doctor or would you expect to have other workload to be reduced elsewhere?? Many of us are already drowning in telephone messages which get added to the end of surgeries. As has been said above too easy access such as firing off an email can reduce the ability/responsibility of patients to actually consider if they really need to be seen or can be bothered to get up to the doctor.
    will improve access for the 'worried well' and anxious at the cost of the elderly, poor non internet connected and non English speaking patients

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  • Dear Ivan,
    Because they are not cost neutral, do not overall save consultation time and merely lower the threshold of access to our over stretched and under resourced service. Sort of simples really. The interesting thing will be to see how Dr Maddan responds to this evidence of lack of impact of his own practice's system in his role at NHSE. These systems have not been through the normal GPIT design, specification, accrediation, fitness for purpose and implementation processes overseen by GPC and NHS Digital via GPSoC and as such are procured at risk. Will he now call for the £45M to be re-allocated to something that we know actually works?
    Paul C

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  • It's obvious without doing a study that this will not save anytime. Someone has to read and action the emails!! Things can very easily be lost in translation. There is no replacement for actual dr/ patient contact so stop wasting resources.
    This is more about convenience for the 'consumer' and I can't see any real benefit. Even people wanting endless sicknotes need to have a consultation or why don't we just give them the blank med 3 pad
    We already have online prescription and appointment booking most other queries need human interaction in health care surely or do we ditch what we were taught about dr/patient communication

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  • We briefly offered e-GP as promoted by our CCG, but have subsequently been asked by our medical defence union whether we offer this service. We have since withdrawn this service awaiting a response from the defense union. i can only imagine that fees may go up given their interest.

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  • No 💩Sherlock

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  • Rogue1

    Just let me have a listen to your chest, sorry I cant.
    Just let me have a feel of that swelling, sorry I cant.
    Just let me have a feel of your joint/test it, sorry I cant.
    Let me check your BP, sorry I cant.
    Let me have a look in you ear/eye/etc, sorry I cant.
    What are we actually doing here apart from pandering to JH, and his cronies?

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