GPs warn of 'open floodgates' as 84% say e-consultations have driven up workload

More than four fifths of GPs say e-consultation systems adopted in the pandemic have driven up practice workload - and half have defied calls to keep the systems on 24/7, a GPonline survey reveals.

GP workload has risen (Photo: sturti/Getty Images)
GP workload has risen (Photo: sturti/Getty Images)

A total of 84% of 663 GPs who responded to the GPonline poll said that adopting e-consultation tools during the pandemic to support patient triage in line with NHS England advice had increased practice workload. Only 3% of all GP respondents said adopting e-consultation tools had decreased workload.

Just one in 10 GPs said they agreed with guidance in NHS England's latest standard operating procedure (SOP) for primary care, which advises practices to make e-consultations available to patients ‘at any time’.

The poll found that GP practices had widely chosen to defy the advice. Of 343 GP partners who responded, 50.3% said they did not keep e-consultation tools on 24/7.

GP workload

Many GPs left comments warning that e-consultations had 'opened the floodgates' to large numbers of additional requests from patients and triggered an 'exponential rise' in workload for practices.

The findings she more light on pressures faced by GP practices during the pandemic. Analysis of RCGP data by GPonline last week showed that GP consultations currently outstrip levels seen before the pandemic, with 8.4% more in weeks 16-20 of 2021 than over the same period in 2019, while clinical administrative work that includes messages to patients has rocketed.

GPonline has previously reported that GPs and their teams are facing a 'tsunami of work' created by huge backlogs of cases, a shortage of GPs and continuing COVID-19 disruption.

The BMA has told GPonline it is aware of a 'growing number of concerns' from GPs around the delivery of online consultations - stressing decisions around switching systems on had to be left to practices.

Online consultations

The updated SOP in May explained that ‘switching off online consultation systems out of hours is likely to be less convenient for patients and reduce patient satisfaction’.

But GPs responding to the survey argued that keeping systems on 24/7 was creating ‘unlimited capacity for queries’ and piling pressure on GP teams to keep up with demand - in some cases increasing activity fivefold.

Many agreed that encouraging greater access to online consultations was lowering the threshold for patients to present with problems. GPs also said that it was adding to a relentless workload that was ‘unsafe’ for them and patients.

One GP said: ‘I was initially happy with the system but the number of e-consults have increased exponentially. People are sending e-consults at all hours of the day and night and at weekends, when they should be encouraged to phone the out-of-hours GP.

Consultation threshold

‘Some patients are sending several e-consults per week with very minor ailments whereas they would have previously let things resolve over time. The problem is that once it is submitted, GPs take clinical responsibility so it has to be acted on, adding to workload.’

Another argued that access to primary care had to be limited like in secondary care. They said: ‘There is a cost to unlimited access which has not been factored into any funding arrangement.

‘Online access leads to [clinicians] arriving on a Monday to dozens of consultations which have to be added to the normal working day. This has led to unmitigated stress… primary care is failing fast - we cannot keep up with the demand.’

Other GPs warned that opening up online consultations more widely could worsen health inequalities. ‘[This] disadvantages those who do not have access to online services, such as the elderly and financially vulnerable. [Unlimited] access gives patients too much access and takes away their ability to utilise any self-management techniques.’

Safe practise

The BMA previously stressed in a GP committee bulletin that practices were not currently legally obliged to offer online consultations during core hours - saying it was up to teams to determine how best they use e-consultations.

BMA GP committee Dr Richard Vautrey, said: 'While many practices have found both remote triage and online consultation systems helpful in managing demand, workload and safety, some practices find these systems in fact increase demand and workload pressures.

'With this in mind, it’s important that the government allows practices to make decisions on how best to use online systems - including what hours they are available - at a local level. It’s only by working with GPs and practices that it can ensure that these systems actually help with triage and workload management to enable the delivery of a safer and more accessible service to patients.

'There’s a risk that instead of streamlining processes and reducing workload for practices, online consultations have the potential to have the opposite effect. It’s clear that more work needs to be done to understand the impact of this on practice workload, and in turn, patient access,' he added.

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