Online consultations may not reduce workload, study finds

Online GP consultations may increase primary care workload and costs and will only help improve efficiency if uptake by patients dramatically increases, a new study has found.

Research by the University of Bristol published in BMJ Open evaluated the use of the eConsult system in 36 practices in south west England over a 15-month period. eConsult allows patients to submit their symptoms to their GP via the practice website and the practice commits to providing a response by the end of the next working day.

NHS England released £45m of funding earlier this month to support the roll out of online consultations to practices across England. It says that online consultations ‘free up time for GPs, allowing them to spend more time managing complex needs’.

However, the study found that patient use of the system was low. Over the 36 practices there was a mean of two e-consultations per 1,000 patients a month. Nearly 60% of all e-consultations took place Monday to Wednesday, with use declining towards the end of the week.

The researchers found that 38% of the online consultations resulted in a face-to-face consultation and a further 32% resulted in a phone call from a GP.

Follow-up face-to-face appointments resulting from an e-consultation ‘tended to be longer than the national averages’, the researchers said. Collecting information from an e-consultation ‘may not make subsequent consultations shorter, and it is possible that it increases, rather than reduces, clinical workload’, they added.

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A study published in the British Journal of General Practice last month also suggested that online consultations may not improve practice efficiency and could increase overall GP workload.

Reasons for online consultations

Over a fifth of all e-consultations in this latest study were for administrative reasons, such as requesting a sick note or repeat prescription. The next most common reasons related to infections and musculoskeletal issues.

The study did say that online consultations could be amended to improve efficiency. They suggested that if patients had a medication query they could be automatically directed to booking a telephone consultation, which would save time for patients and clinicians.

The research also found that women were twice as likely to use e-consultations as men (64.7% of consultations were with women compared with 35.3% with men) and half of all users were aged 25-44 years.

Dr Jeremy Horwood from University of Bristol’s Centre for Academic Primary Care, said: 'There is a central government drive to move to these systems. However, our research shows that they need to be carefully implemented and effectively marketed to yield the benefits that politicians are hoping for. Online consultations may have value for some patients, such as straightforward medical enquiries, but they cannot replace face-to-face consultations in situations which are more complex.’

Dr Murray Ellender, chief executive of eConsult, said: ‘Online consultations may not be a silver bullet, although our experience shows they could be a significant part of the solution, and have evolved a long way since this study was carried out. It is encouraging to note from the evaluation that more than six in 10 online consultations did not require a face-to-face consultation, and quantifiable feedback from patients indicates they value having this option.’

An NHS England spokesperson said: ‘A number of practices are already running online consultations and have found them to offer both patients and GPs a quicker, more convenient option than face-to-face appointments. This is why we have committed £45m over the next three years to give every practice across the country the chance to offer online consultations.’

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