Email consultations may not improve efficiency, researchers warn

Online consultations in general practice that forgo face-to-face contact with patients may not improve practice efficiency and could increase overall GP workload, researchers have warned.

Email consultations (Photo: JH Lancy)
Email consultations (Photo: JH Lancy)

The advantages of email-based, online consultation systems in general practice are unclear, according to a study published in the British Journal of General Practice (BJGP).

Researchers evaluated a system developed at one anonymous early-adopter UK practice. The system - given the pseudonym 'Tele-Doc' in the study - allows GPs to communicate with patients by email only, without audio or visual contact, and is already set up across 231 practices.

The researchers concluded the system could work well for simpler problems, but was ‘often ill-suited’ to consulting about complex problems. They interviewed the clinicians and administrative staff at the practice, alongside the system's developers.

They also had concerns that removing face-to-face contact and emotional context from the consultation could be a serious problem – no matter the complexity of the patient’s problem – which could limit what is achievable by the system.

Online consultations

Uptake by patients was low, and the researchers found there was little evidence that efficiency gains were realised, ‘despite extra effort and administrative time put in by practices’.

The scheme could provide a ‘welcome variation’ to GPs’ workload, they said, but the results suggest that much of the work of the consultation was redistributed from GPs to patients and administrators, sometimes causing misunderstandings.

Interest in using technology to streamline patient interactions as an alternative to face-to-face consultations has been mounting as GP practice workloads rise and practices struggle to fill vacancies.

NHS England plans to offer support to all practices in adopting online consultation systems, and has already committed £45m to do this.


Although telephone consulting is well-established in general practice, exchanging email is not as common, with just 6% of practices reporting they use email regularly.

The researchers said: ‘GPs welcomed varied modes of consulting, but the aspiration of improved efficiency was not realised in practice.

‘Tele-Doc offers a new kind of consultation that is still being worked out in practice. It may offer convenience for patients with discrete, single problems, and a welcome variation to GPs’ workload.

‘Tele-Doc’s potential for addressing more complex problems and achieving efficiency is less clear, and its adoption may involve unforeseeable consequences.’

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