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Practices being ‘obstructed’ from turning off weekend e-consultations


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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.

READERS' COMMENTS [14]

Richard Page 19 May, 2021 11:09 am

‘The majority understand that eConsult isn’t creating demand that wouldn’t ordinarily exist, it is unmasking demand that would otherwise remain hidden.’ What rubbish! This is simply another open door for more work and medicalising problems that people can deal with themselves or through self medication & pharmacies.

Keith Greenish 19 May, 2021 11:52 am

Did nobody see this coming? Experience in GP land – 43 years in my case – shows that consultation availability, like nature, abhors a vacuum, that patients will nearly always choose to consult a GP, if availability exists, rather than an alternative service, and that the more appointments that are made available the more patients will use General Practice as a de facto self care advice service rather than take responsibility for themselves. Did NHSE include digital consulting as one of the 10 high impact actions because it was necessary or simply because IT makes it possible? Will anyone be able to count the number of conventional appointments that have been avoided by patients taking the eConsult option and tell us that eConsult has reduced our overall workload? Of course not, the rising total figures will speak for themselves.

Of course Dr Ellender makes out eConsult is simply revealing demand that previously existed where in fact that demand when there was largely self-maneagable, he stands to profit from his business and is not going to downplay it.

Without an adequate core GP workforce rather than non doctors General Practice in any guise is doomed yet this is another ill-judged solution that is likely to further reduce the number of GPs and hasten the demise of the service.

It makes me very sad that the finest primary care service in the world is being sacrificed on the political altar of 24 hour availability of routine care and self care advice.

terry sullivan 19 May, 2021 12:08 pm

are not gps self employed?

John Graham Munro 19 May, 2021 3:09 pm

Apparently GPs have been working flat out during the pandemic and are on the verge of collapse——–so they’re not going to play any more and tell their mum

Patrufini Duffy 19 May, 2021 3:57 pm

*******ALERT

eConsult’s co-founder is Arvind Madan, ex-NHS England National Director of Primary Care. Yes, the same man Devil’s Advocate that said those remaining GP surgeries should be “pleased” that less viable businesses were shut.

Embed your eConsult link in the 275th tab of your website. PERIOD. Or just fund his pocket money.

Akhil Shial 19 May, 2021 6:25 pm

To all practices that feel obstructed by eConsult – VOTE WITH YOUR FEET AND MOVE TO ANOTHER PROVIDER IN SEPTEMBER.

All contracts are due for renewal in September, there are multiple providers available on the Framework.

Mr Marvellous 19 May, 2021 6:46 pm

Akhil,

Good point.

Do you have any experience as to which is the easiest to turn off?

L B 19 May, 2021 7:22 pm

John Graham Munro. Most GPs HAVE been working flat out during the pandemic and ARE on the verge of collapse….. no “apparently” about it. Your negativity on this forum is adding to the already low morale. Please think before you post such nonsense.

John Graham Munro 19 May, 2021 8:52 pm

LB———-THE REASON FOR MY SARCASM IS THE NEVER ENDING MOANING——–DO SMETHING ABOUT IT

bob the builder 19 May, 2021 10:04 pm

JGM – it was nice to have a temporary reprieve from caps lock – often those who shout loudest have the least to say. What you need to understand is that those who can do something about it already have, or are about to ……….hence the increased pressure on those who are left and don’t have such escape routes open to them and are too exhausted/demoralised to stand up and fight. It’s a bit of reverse physics really: there is a critical mass of GP manpower – once the level falls below that critical mass the rest of GP will implode on itself in an exponential fashion and disappear into a black hole.

John Graham Munro 20 May, 2021 12:49 am

bob the builder———When you have a moment in your busy schedule, I suggest you take a look at a contributor’s comment on those who like to hide behind anonymity

Andrew Jackson 20 May, 2021 10:14 am

BTB and JGM
both of you have valid points
the ‘best bits’ of a current primary care are currently those bits where you are not doing a day to day GP job and they usually pay more!
However these best bits (including the new well protected additional roles and to a degree locum work) only exist because there is a pool of GPs ‘mopping up’ the excess work who are usually the lowest earners.
This pool is shrinking fast and it is not unreasonable for us to expect our political representatives to fight for a manageable workload and the RCGP to design a sustainable work plan that they recommend GPs can aspire to have as a long term career.
I have no friends outside of medicine who don’t work monday to friday but I currently know no GPs who do this-it is a ludicrous career offer to highly trained intelligent people to be unable to promise them a sustainable full time job.
This unfortunately can’t be achieved without probably collapsing primary care as we know it but it is inevitable anyway on its current trajectory.
The issue of doing something about it does require our representatives to present us with some alternative options as just becoming a locum to get out will cost all of us in the end.

David Church 20 May, 2021 9:30 pm

I don’t see why it needs to be ‘turned off’. just don’t log-in to read them on weekends.
It is useful for patients who are working in the week to be able to send the query at the weekend, but it does not need answering same day – indeed, if it is clearly ‘out-of-date’ and no loger relevant on monday/tuesday, it can be dealt with much faster.

David Church 20 May, 2021 9:34 pm

I am not sure iff oll the posters on this site are GPs, but there are valid points : resistance needs to be coordinated by a strong Union, otherwise it will be undermined by those who are too busy to find out the facts themselves when being told by ‘authorities’ that something is compulsory.
One practice was forced to accept patient registrations from outside practice boundary because instructed by an LB that NO registration request could be refused – until I took a stand where the patient’s residential address was in a different country of hte UK, and therefore 6 hours travel outside uor practice boundary, which MUST be rejectable on grounds of stupid travelling time for home visits! i won.