GP practices wanting to turn off e-consultations at weekends and evenings are facing ‘resistance’ from their digital provider and CCGs, GP leaders have warned.
Online platform eConsult has ‘delayed’ some practices’ requests for more than a month, directing them to their CCG for permission to turn off access out of hours, grassroots organisation GP Survival told Pulse.
An eConsult spokesperson said it will ‘actively’ support practices that want to switch off the service at the weekends but that it ‘contractually needs’ permission from CCGs that procured the service on behalf of practices.
It comes as practices are struggling under ‘unmanageable’ demand compounded by the service, according to LMC leaders.
GP survival founder Dr Alan Woodall told Pulse that practices asking to switch off eConsult access over the weekends have been delayed or directed to their CCG for permission, although they do not contractually have to offer the service out of hours.
He said: ‘We are aware that many practices have found it very difficult or feel as though they are being delayed when asking for changes to be put in place.
‘The CCGs do not have the right to block this but nor should the providers be responding to surgeries [saying] that they need to get permission from the CCG.’
Dr Woodall added that ‘delays or resistance’ from providers or CCGs have lasted more than a month for many practices – and that ‘significant numbers’ of GPs are affected.
Mid Mersey LMC vice chair Dr Samir Shah told Pulse a local practice also faced resistance when requesting a weekend switch-off, with an eventual resolution taking ‘around a month’.
He said: ‘It took a little while because initially eConsult said no, then we put a bit more pressure on it and the CCG eventually created a standard operating procedure the practice managed to comply with.’
The practice had to justify the request by completing a nine-question form, despite already battling ‘very high’ workload, he added.
But while the practice has been able to remove eConsult access fully at weekends and has a notice on its website asking patients not to submit requests outside opening hours, patients can still do so overnight, he added.
He told Pulse: ‘The issue is that it still essentially gives 24-hour cover – people can do eConsults Monday to Friday 24/7. It’s basically adding out-of-hours work into your GP work.
‘It’s still pretty much an open tap at the moment, but one of the things we’re trying to work on is for it to tally with GP opening hours.’
GP Survival is calling for ‘urgent action’ from the BMA and NHS England to support ‘struggling’ practices, including a joint letter to CCGs confirming there is no contractual requirement to leave access open and that switch-off requests should be ‘actioned without delay’, Dr Woodall said.
In its latest GP bulletin, the BMA said it is ‘aware that there have been a growing number of concerns relating to NHSE/I guidance suggesting, and local commissioners requiring, practices to maintain online consultations and remote triage systems’.
It confirmed that practices have no contractual duty to leave any form of online provision accessible out of their contracted hours, although it has been agreed as part of the 2019 GP contract that it will ‘eventually’ become contractual for practices to offer online consultations during core hours.
The bulletin said: ‘GPCE also agreed that practices should offer online consultations as early as possible, provided that the necessary infrastructure is in place, but it would not become a requirement until it is entered into the contract regulations.
‘It is therefore for practices to determine how best they use online consultation systems, including what hours they are available.’
Meanwhile, GP leaders told Pulse that practices are facing ‘unmanageable’ pressure from eConsult forms and they fear that colleagues will resign.
Dr John Allingham, former medical secretary for Kent LMC, said: ‘It does seem odd that we’re allowing 24-hour access to a service that’s open from 8:00 to 6:30.
‘The theory is that it won’t increase the workload but simply move the workload into a different place. But it seems that the more ways you give people to access healthcare, the more the numbers go up.’
He added: ‘We need recognition from NHS England and from the Government that the demand is unmanageable. We’ve got a lot of doctors who have been working flat out through the pandemic and are on the verge of collapse. We are in danger of caving in big time.’
Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer told Pulse that her practice was an early adopter of eConsult and has ‘noticed it has become another unchecked unlimited portal of demand, to add to the rest’.
She said: ‘Ultimately, we may have to set limits. It can’t simply be permitted for the hamster wheel to spin ever faster.’
And Lincolnshire LMC medical secretary Dr Kieran Sharrock added: ‘It is creating a significant workload burden and doctors are telling me that because of it, they think that they’re going to stop working.’
GP and eConsult chief executive Dr Murray Ellender said: ‘Let me say categorically that we will actively support any GP surgery that wants to switch off our service at the weekends. If a CCG has procured our service on behalf of a practice then we do contractually need to check with them before we implementing this change, but it is absolutely not our intention to slow the process down.
‘It is important to note that only a minority of surgeries choose to switch off at weekends. The majority understand that eConsult isn’t creating demand that wouldn’t ordinarily exist, it is unmasking demand that would otherwise remain hidden.’
He added: ‘By keeping digital triage running 24/7, surgeries can ensure that sick patients who might not pick up the phone to an emergency doctor, or who are unwilling to join the Monday morning phone lottery, don’t get lost outside the system. We always offer to work directly with practices that are struggling to manage demand. We have plenty of GPs on the team and completely understand the pressures general practice is currently under.’
It comes as an NHS England letter ordering practices to offer all patients face-to-face appointments if that is their preference has caused anger among GPs, amid ongoing concerns about GP workload.