This site is intended for health professionals only

Killing us softly with online access

‘Improving access’ to primary care for patients has long been hailed as a worthy aim by the powers that be, most recently enabled in my area through the introduction of digital triage platforms.

My experience of having 24/7 e-consult requests is the complete loss of any fragile boundaries that we had. My clinic used to have a start and end time. Now, the ever-growing screen of patient requests is a like a tap that you can’t turn off. Sometimes it drips, and sometimes it pours.

Any kind of bank holiday causes a flood. Psychologically speaking, I now work with a sense of constant threat – how many more will come? Work is not a safe place, but has become an enemy to defend against.

Improving access for patients has simply increased demand and reduced our capacity to meet it, as resource is needed to process every request. Adding another lane to the motorway just means the cars come faster towards us.

We may be processing more demand, but this isn’t the same as meeting health need. Rather, it gives space for the smallest of health anxieties, after the shortest of time periods for the digitally-savvy.

Perhaps this is a version of the Inverse Care Law? Clearly there is a spectrum of patient requests, many of which absolutely need GP time and care. I’m not wanting to judge what may seem to be ‘health anxieties’ as we continue to experience national health anxiety in the face of pandemic life.

However, I am saying that we in primary care are drowning, and I don’t think I can cope with any more improved access measures. Our sink is simply not big enough.

Dr Eleanor Worthington is a GP in Harrow, London, and clinical director of Harrow CCG Integrated Care Programme


John Graham Munro 13 July, 2021 8:16 pm

You do not have to work like that in order to bale out this government——-do not fall for the ”we’re all in this together” banter—-close your doors and go home——-what thanks have you had so far? ——clapping—–a 1% pay increase,——and ahem a George Cross medal from the Queen——-As the Rolling Stones once said ”Here comes your nineteenth nervous breakdown”

Turn out The Lights 13 July, 2021 8:28 pm

Switch off e consult.I will not use it ever it a red line say no.Or could you send a standard email to either make a FTf or phone appt.Demand needs to be controlled or the government need to increase supply.The current system is unsustainable and failing rapidly.

Patrufini Duffy 13 July, 2021 8:37 pm

Turn it off. Take it off your website. Or embed it in a sub tab somewhere else. You aren’t getting a pat on the back in 10 years time. Just increasing your litigation risk profile exponentially and justifying Arvind Madans salary as eConsult co-founder. More consults, equals more follow-up, equals more addiction, equals more consults, equals more follow-up and the dumb UK cyclical hypochondriasis continues. Neurosurgeons and cardiologists aren’t e-consulting didly squat with the public, you’re taking the massive hit for them. All surgeries need to re-evaluate their raison d’etre, very quickly.

David Banner 14 July, 2021 2:48 am

The mistake people made was to think that e-consults would reduce surgery appointments , thus improving efficiency whilst improving access. The same applied to those dreamers who thought remote consulting would do the same.
The road blocks to access are the only reason Primary Care staggers on. Patients with minor issues are disincentivised by the thought of phoning 20 times or slaying the dragon on reception. Once these barriers are removed, there is a deluge of unmet and bottomless demand, the majority of which is relatively trivial.
The New Normal is fool’s gold. Turn off e-consults, clamp down on telecons, and return to the Devil You Know of the Old Normal.
I’d rather be up to my waist in s**t than up to my neck.

Steven Hopkins 18 July, 2021 1:02 pm

Why not simply charge for our services? Demand has no limits because there is no cost to the customer. Just as a small charge for carrier bags reduced their use by over 80%, Charging patients £20 for a consultation will dramatically reduce our work load. With increasing numbers of colleagues retiring and burning out, we need to accept that the current NHS model just doesn’t work. Elinore has hit the nail on the head. There is no limit to demand.

Finola ONeill 19 July, 2021 10:45 am

Digital access is not a plan to give patients better access. It’s a plan to outsource primary care to private digitally based primary care services. Babylon Health, GP at hand, push doctor. Tory Donors and lobbyists want their “share” of the pie. Econsults when we are closed are dangerous. Red flagged ones sit there while medicolegally when does it become a consultation. I have had suicidal patients who have ticked the yes to that, don’t get side lined to phone 111, etc. It’s not for the patients, it’s not for us. It’s for private healthcare companies. Sink us with work and then outsource the digital access and digital/telephone triage. It’s already happening. They need to give the money to primary care, PCNs so they can employ more staff and give the service the patients want and the one we want to give

Steven Hopkins 20 July, 2021 8:28 am

Hi Fiona,
More money won’t generate more doctors. Our collogues are burning out, loosing heart and moving from the NHS to employers that provide better work conditions for themselves but at the cost of the vulnerable who rely on the NHS.
Our CCG provides us with reams of policies and different forms that all look similar and only serve to take up time and wasted energy on complex referral pathways. Back in the Eighties and Nineties referral was simple. You wrote a letter to the consultant with whom you had had contact through one of the many drug company sponsored local meetings. He saw the patient. Now we have acres of bureacracy as the NHS tries to find something to do with all the money it has got and cannot spend on clinicians who don’t exist.
How much of your time is wasted with the CQC? (That failed to stop the Staffs hospital crisis, the Bristaol Peadiatric Heart Surgery Crisis etc). How much time do you waste on Annual Appraisal and Revalidation? How much money is wasted on the local CCGs who merely serve to obstruct, obfuscate and draw doctors away from clinical practice. How much money have we wasted by trying to be “consultants in the community” when what we need is doctors seeing patients.
The refusal to cut our cloth according to our means is leading to a collapse of the NHS. We are driving that fasilure and we cannot blame private companies for filling the void.