As GPs we are constantly told to ‘work smarter not harder’ to manage demand, and as you prepare to land another right hook on the jaw from which this statement emerges, hear me out. Among the options sometimes suggested is more use of the e-consultation. In our practice we have been trialling a system for a number of months whereby patients fill in an online symptoms questionnaire, which doctors review to determine what action to take.
It is not the magic wand to solve all your access problems, but with a little thought you may find it is another piece in the jigsaw. Here are some things to bear in mind before you start:
1. Is this going to increase demand?
One of our first concerns was whether it would just be another way for patients to contact us who may not otherwise have done so. This may depend on your current level of accessibility.
Our practice has always had open access by telephone, and our experience has been that the e-consultation has absorbed some of the telephone work. While it has not specifically reduced the workload, it does mean the work can be dealt with in a more convenient manner for both practice and patient. For instance, it doesn’t result in games of answering machine ping-pong.
2. Is it going to be too complicated?
If the e-consultation system is going to be yet another administrative headache, any benefits from streamlined access could soon be lost. The solution we are using is still not fully integrated into the clinical system, and so requires us to link the incoming request to the relevant patient record and allocate a doctor to deal with it.
We hope that in time there will be a direct link into the system to bring these automatically into a workflow in the clinical system.
3. Will it integrate with your current systems?
Look at the available systems and how they work with your electronic medical record. Remember this is a consultation and needs to be recorded in the medical record. You will also need to refer to the medical record to deal with the problem (as with any consultation), so the more closely the system will integrate, the better.
4. Who will be accountable for the e-consultations?
Look at how the information for e-consultations will come into the practice. Will you need someone to allocate the incoming requests? How will these be allocated? Can it be done through a task or workflow module or will you need to create a new ‘surgery’? Who will be dealing with the e-consultations: the patient’s accountable GP, the duty doctor for the day, or another allocated doctor? How will you communicate back to the patient? At present we normally message our reception team to ask them to follow up with patients by phone, and so far this has generally worked smoothly. The advantage of a phone call is that you know that the message has been transmitted.
5. Can any patient use the e-consultations system?
When talking about technology, many people voice concerns that this discriminates in terms of access, but while patients with no internet access cannot use this service, it may improve their access to appointments by reducing the burden on other routes. At our practice in the last six months, 21% of patients accessing the service were over 50 while 8% were over 60.
6. How do I make sure patients use it?
Promotion is very important. Plan how you will do this in line with your normal channels of communication with your patients. We have used large posters and banners in the waiting room, messages on the telephone recording and a prominent banner on the website.
7. How much will it cost?
There are a number of providers now offering an e-consultation service. Our system was financed through our local Prime Minister’s Challenge Fund scheme. Make sure you get a clear quote before committing to a provider and consider whether the costs will be justified by the benefits.
It is certainly worth checking with your CCG to find out what development projects and funding streams are available to you. The main benefits will be in improved access and there are often pots of money available to support this.
8. Will I be covered by my medical indemnity?
The defence organisations are all aware of the developments in this area. Our e-consultation supplier had already briefed the defence bodies about its product and all we had to do was notify our policy provider that we would be using it. It had no impact on our indemnity costs.
Dr Geoff Schrecker is a GP in Sheffield and chair of the EMIS national user group
