What we did
We are a growing practice in Orpington, Kent, of 8,500 patients, three GP partners and two salaried doctors. About two years ago we decided to set up systems to enable patients to contact us by email because we didn’t have the capacity to deal with the numbers of patients contacting us by phone.
They can email us in two ways. First we have an urgent triage email, which is checked by the doctor dealing with urgent on-the-day appointments between 8 and 10am. The doctor calls the patient back that morning for a phone consultation, inviting them in if they need a more complex consultation.
This is the same service that patients get if they phone first thing for an urgent appointment, and it eliminates the need for them to battle to get through on the switchboard. For example, a mum who has been up all night dealing with a vomiting child can send an email that night that will get picked up first thing.
Our patients can also send emails asking for advice to a general email address, which we respond to within 48 hours (during the working week). A member of admin staff accesses the account once a day and in most cases forwards the emails to the duty doctor. These can include issues such as prescription queries, requests for test results or referrals, photos of skin rashes and patients wanting antibiotics for a UTI. This service is particularly useful as we have a lot of commuters among our patients and can send electronic prescriptions to a pharmacy near their work, which saves time for GPs and patients alike. Older patients are quite happy with the email system – over-70s email about test results and other issues.
Challenges
One of the main concerns was that we would be overwhelmed. But as yet, patients have not abused the system and the workload is manageable. We also don’t have trouble with patients emailing the urgent triage inbox with a non-urgent problem, but if this happens we email back explaining their mistake. We also send an out-of-office reply to emails sent to the triage account at times when the account isn’t checked, reminding patients to ring if their problem is urgent. If an urgent email ends up in the non-urgent inbox, admin staff flag it for a GP.
We’ve addressed the medicolegal repercussions partly by gaining patient consent to email them before we respond to anything they send to us to check their identity. From then on it is the patient’s responsibility to ensure their email is secure. We warn them that while NHS servers are generally secure, their private email addresses are not and they may want to be careful about information they share. Recently, a member of admin staff accidentally revealed 4,000 patient email addresses while sending out a patient newsletter. While no clinical information was shared, we now have the protocol of making sure two people check an email if it’s being sent to a large mailing list.
Results
We estimate we’ve saved between five and seven GP appointments a day as a result of using both email systems, although due to population growth it’s difficult to calculate precisely.
Up to 10 triage emails come to us a day requesting a phone call from the doctor. We deal with about 40% over the phone. In terms of general emails from patients, there are about 30 prescription requests and up to 20 general queries each day. Fewer than 10% of general queries result in a face-to-face appointment. We get positive feedback on a daily basis from patients.
Because of the way this has improved our access, we are a rapidly growing practice, taking on 1,000 patients in the past year. Although it seems a daunting task to grapple with at first, I would definitely recommend other practices give an email system for patients a try.
Dr Bartolomiej Tsyzka is a GP in Orpington, Kent
