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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.