This site is intended for health professionals only


Time to pull the plug on e-consults


fruit and veg prescription


I’m at a disadvantage here, given that I’m writing in the past and you’re reading in the future. There will have been a lot of fallout in between. After all, the A-bomb dropped today. That’s A as in ‘Access’: NHS England’s bulletined and bulleted list requiring us to throw open our surgery doors and offer F2Fs on request.

In other words, they’ve chosen to blow up our Covid-based version of general practice in the hope that the wreckage will fall roughly in the shape of the Old Normal.

We should have seen this coming. Society’s opening up, and we’re already getting a thrashing in the media, so maybe the idea was to head off the inevitable ‘I can see my hairdresser yet I can’t see my family doctor’ GP-hate columns.

On the other hand, it’s sudden, draconian and sits uneasily with NHSE’s mantra of thanks for our efforts and protestations that they know we’re open, it’s just the public and media that are too stupid to get it.

Whatever. It would appear the current ‘ask’ of general practice is something along these lines: continue with Covid jabs, expand flu jabs, reboot chronic disease management, resurrect enhanced services, jump raised QOF hurdles, move the mountain of mental illness, seek and destroy the pathology backlog and, now, return to business-as-normal access. Doubtless we’re responsible for mopping up our own blood, sweat and tears, too.

Ok, we’ll do that. But something’s got to give. We need more than grateful platitudes and hollow support to survive this particular mushroom cloud. We’ll give you access-as-usual, or something close to it, as long as it’s just that. Which means, of course: scrap online consulting.

What was last year’s contractual aspiration has become this year’s living hell. We knew it would, but hell turns out to be far worse than we’d feared. Whoever said online consulting would dilute or divert work was malicious or mad because, of course, it does the exact opposite. It opens the floodgates to the neurotic, impatient, whimsical, intolerant, obsessive, angry, entitled, manipulative and vexatious. Now these people can torment their GP repeatedly, at all hours, from the comfort of their own caves, rather than just in contracted hours like they used to.

One significant reason for this is something the Government would like to pretend isn’t true: a small built-in delay to accessing healthcare is a good thing. Most symptoms resolve given some time, and if they don’t, then at least they evolve into something meaningful. Remove the barriers to consulting and you just end up with perplexed doctors, overmedicalised patients and yet more work, and if you don’t believe me, check out the Monday morning e-consultation list. And no, I’m not worried about the urgent or seriously ill, there are already enough portals for them.

So, NHSE, while you’re opening one door, encouraging patients to see their GP, how about quietly locking another? Without fuss or fanfare, just contractually unplug e-consultations. An A for an E. Hey, maybe it’s already happened?

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield

READERS' COMMENTS [8]

Mr Marvellous 1 June, 2021 1:10 pm

Since BBOLMC has confirmed we’re not contractually obliged to have this turn on (at least for the moment), I’m not sure why so many are still doing them.

We returned from the lovely bank holiday weekend to find we had exactly 0 to deal with.

It’s been an OK day so far….

John Graham Munro 1 June, 2021 2:28 pm

There are plenty of G.P.s on Tele –in the Newspapers and in Magazines— having nothing better to do than promote themselves—- who can answer queries thrown up by the likes of e-consult

Patrufini Duffy 1 June, 2021 2:41 pm

They plugged you into the “grid”: next to Deliveroo, Pharmacy2U and Uber. Have what you want, when you want – but this time – pay nothing. Primary care on the cheap, de-professionalised and more “accessible” and open to further buggery and risk. A fine art, made into mass printing.

Dirk König 3 June, 2021 6:22 pm

It took our practice manager no less than 6 months to obtain ‘permission’ from the CCG to have our eConsults switched off at least at the weekend, and now it just transpired that providing eConsults wasn’t even in our contract!
Given our ongoing staffing and recruitment crisis I have just contacted eConsults directly and (without any long arguments) they just agreed to switch it off immediately outside all non-core hours!
Let’s see what effect this will have on our appointment system and workload, as the inevitable next step would have to be a total switch off…

Generic Locum 4 June, 2021 7:02 pm

But but…

“B S 21 September, 2020 1:45 pm
Nonsense. AskmyGP is wonderful. It effectively adds one WTE GP to the practice. Medical students who see this in action say how much better it is than any other digital platform. My salaried GP was stranded abroard due to the flight shutdown. I survived – easily – because of and entirely because of AskmyGP. Patients didnt even notice. AskmyGP is a hyperefficient, GP friendly solution.”

David Banner 7 June, 2021 1:39 pm

There has always been a misconception in Primary Care that demand is finite, so better access will sort it out.
Wrong.
Every fix in the last 20 years (WICs, 111, overspill appointments etc) have rapidly become oversubscribed, whilst pressures on A&E/GPs has continued undiminished.
Sadly, beneath the demand we are aware of is a bottomless pit of demand we are blissfully ignorant of lying dormant, but unleashed by improved access. Econsults merely give unfettered access to many who wouldn’t have bothered fighting Rottweiler receptionists, but have no issues writing a lengthy email at 2am whenever they feel like it.

Dylan Summers 10 June, 2021 11:26 am

@David Banner

Well said.

I also think the public discussion around GP appointments unhelpfully confuses two issues: access and capacity.

A problem with access would mean that patients are not managing to fill the available slots because they cannot access them. This would manifest itself in empty appointment slots – therefore it is pretty clear that most surgeries do NOT have an access problem.

What surgeries are mostly struggling with is not an access problem but a capacity problem – there are no slots to fill. This cannot be solved by improving access, only by increasing capacity,

Dylan Summers 10 June, 2021 11:27 am

(for “no slots to fill” read “no MORE slots to fill”)