How to improve online GP consultations

NHS England is promoting the use of online GP consultations through a £45 million fund. But unless these systems are carefully implemented and effectively marketed, they won’t yield the benefits that policymakers are hoping for. Indeed, they may create more work for GPs rather than save them time, as research published in BMJ Open and funded by the NIHR at the University of Bristol has found.

NIHR CLAHRC West, in collaboration with the One Care Consortium, evaluated the effectiveness, acceptability and impact of implementing eConsult in thirty-six GP practices in Bristol, South Gloucestershire and North Somerset. eConsult is a web-based platform that patients access from their GP practice’s website. It enables patients to complete a questionnaire and submit their symptoms online to a GP. The system also provides self-help, advice and signposting to 111, pharmacy or local services. Our evaluation used:

• website usage statistics
• patient surveys
• electronic medical record data about the actions taken by the practice following an online consultation
• practice staff interviews

We found that the system did save some patients having a consultation with their GP. However, 70 per cent of online consultations resulted in either a face-to-face consultation or a telephone call from a GP. In these cases, because GPs first assessed the online consultation, and then assessed the patient on the phone or face-to-face, staff felt they were duplicating work.

Improving the use of online consultations

Online consultations may have value for some patients, but they cannot replace face-to-face consultations in situations which are complex. However, our findings suggest that online consultations may be efficient for some patient queries. We suggest ways that implementation of online consultations could be improved.

Simple enquiries work best for an online consultation. Our research suggests that online consultations worked best for routine enquiries that didn’t need a follow up conversation or appointment, such as getting test results, fit notes, medication queries or follow-up advice for ongoing conditions.

Online consultations need careful marketing. Online consultations cannot replace face-to-face consultations when diagnosing new or complex symptoms. Practices should consider marketing their system to encourage patients to use online consultations for routine enquiries or follow-up advice and discourage use for more complex enquiries where a face-to-face appointment will probably be needed. Developing guidance for patients for when and how to use online consultations can save everyone time.

Online consultation systems need to be carefully implemented. GPs who are familiar with the patient and their condition may be better placed to respond to an online consultation, as they might be more aware of the patient’s care needs. Also, when an online consultation was followed up with a face-to-face appointment, if the GP who initially read the online consultation sees the patient, the consultation could be more focussed and quicker. Practices should, where possible, consider which GPs undertake online and follow-up consultations.

Make sure the patient knows what’s happening. Whilst most patients were satisfied with their online consultation, 14 per cent said that after a week, they still hadn’t heard back from the practice about their online consultation. Communication channels need to be robust, to make sure that all patients know what’s happening in a timely way following their online consultation.

Guidance to help commissioners and practices choose and implement an online consultation system

If commissioners or GP practices are choosing an online consultation system to use:

• Does the system integrate with current IT systems used in the practice?
• Does the system encourage self-help and signpost patients to the most appropriate service e.g. a pharmacy for hay fever or common colds?
• Does the system operate a red flag approach, so if patients’ symptoms seem urgent, they are directed to a service that will promptly review their query?
• Does the system ask patients enough questions so practitioners have sufficient information to make clinical decisions?
• Is the system easy to use for patients and does it use straightforward language?
• Do patients have opportunities to:
  • nominate a preferred GP to look at the query
  • upload a photo
  • request administrative clinical support such as test results, medical certificates or repeat prescriptions, without needing to answer a complete medical questionnaire?

If a GP practice is using an online consultation system, it could be improved by:

• Using signposting to encourage patients to use online consultations for simple conditions or questions, and encourage patients to directly book a telephone or face-to-face appointment for new, complex or multiple symptoms
• Triaging patient queries to direct them to the most appropriate service such as a pharmacy for hay fever or common colds
• Allocating online consultations to GPs who already know the patient
• If a patient needs a follow-on phone or face-to-face appointment following an online consultation, allocate this to the GP who processed their online consultation if possible
• Ensuring that there is a robust system to communicate back to patients the results of their online consultation in a timely way

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