It was no surprise to hear the BMA GP Committee recently call for an assessment of online consultations. During lockdown, most surgeries trialled digital care in some form. Now is the time to step back and ensure that we get the transition right.
What I do find surprising is the support for a bottleneck, advocated in Pulse. Jaimie Kaffash’s editorial argues that a natural barrier between GP and patient prevents surgeries from being overwhelmed with unnecessary requests for appointments.
As a practicing GP, I cannot agree that the best way to deal with rising demand is to prevent access. Forcing all patients back on to busy phone lines might dissuade some time-wasters from crowding the appointment schedule, but in reality there is no way of knowing how many patients in urgent need of access are simultaneously failing to get through.
There is risk hidden in every waiting list, and that risk increases the longer the waiting list grows. Is a patient’s headache simply a migraine, or is it a subarachnoid haemorrhage? Is the pain in your patient’s stomach something trivial, or acute appendicitis?
It is true that some digital health services actively increase the demand for primary care. In fact, a direct line of access often makes it too easy for patients to contact their doctor. When we surveyed 250 GPs about their experience of digital consultation, more than half told us that new digital channels had increased staff stress levels.
Adding email or text without digital triage prioritises ‘want’ at the expense of ‘need’ because it doesn’t enable staff to assess the nature of the patient enquiry before it reaches the GP. This inevitably leads to unnecessary appointments, which create added stress for already overworked staff.
Many eConsult users tell us that when they first added extra channels, such as text and email, they were overwhelmed with requests for appointments. It’s only when they added eConsult to triage these requests that the enquiries became manageable.
This is hardly surprising. Trained staff are much better judges of need than patients. But in the age of Google, many are self-diagnosing and demanding appointments, while the backlog caused by the pandemic has stretched practice resources even further.
Managing demand effectively means that need must be accurately assessed before an appointment is made. But this must be done fairly. Let’s not return to a system that rewards the patients with the greatest tolerance for hold music.
At a fundamental level, the role of primary care is to control access to more expensive (and increasingly stretched) secondary care. That means accessibility to primary care is a principle on which the entire system depends. Preventing access because demand is too high makes about as much sense as removing the cutlery at an oversubscribed restaurant.
GPs are motivated by a desire to help as many people as possible. They hate seeing queues of disgruntled patients. The role of digital should be to help overworked and understaffed practices prioritise the patients who need to be seen. But digital triage can only manage demand against available resource. It cannot lower demand or magically produce more doctors out of thin air.
I believe that digital triage is a route to more GP face-time for patients who need it. Yes, that’s right: digital should create more physical appointments, not fewer.
I have read incorrect and damaging articles accusing GPs of hiding behind pandemic restrictions to deliberately prevent access. Practicing GPs know the truth. None of us want an end to face-to-face consultation. It’s resource we lack – not courage.
Dr Murray Ellender is chief executive of eConsult and a GP in London