Practices should not be required to provide online consultations, say LMCs

Online consultations should no longer be a part of the GMS contract and targets for increasing their use that form part of the PCN network contract DES should be scrapped, LMCs have said.

Close up of hands typing on a computer
(Photo: Marko Geber/Getty Images)

Some 95% of delegates at the online English LMCs conference voted in support of the motion, which also called for the BMA GP committee to negotiate regulations that would give practices the legal right to choose which online systems or consultation methods they use for their population and to scrap any incentives related to the use of online consultations.

LMCs also called for a proper evaluation of the impact online consultations systems have had on practice workload, patient safety and health inequalities, as well as the cost implications of adopting the systems.

Under the five-year GP contract, practices in England were all initially expected to have online consultation systems, which alllow patients to contact their practices via the practice website or an online system, in place by April 2021. This timescale was accelerated by NHS England early in the pandemic as practices were advised to move to a total triage model and instructed to adopt online consultations as part of this approach.

Health inequalities

GPs taking part in the debate highlighted that online consultations were fuelling huge rises in workload and risked widening health inequalities by making it easier for certain groups of patients to access their GP, often at the expense of those with the greatest need.

Dr Abel Adegoke from Wirral LMC who proposed the motion said: 'From my own experience [online consultations] increase the already existing health inequalities.

'My own practice is located in the fourth most deprived ward in England, with about 11% of our population homeless and with no access to digital technology or good internet. Also, my experience is that those who use digital technology tend to overuse and abuse it, so increasing the workload unnecessarily.'

Dr Lisa Harrold-Rothwell from Kensington, Chelsea and Westminster LMC in London, likened the use of online consultations to opening another lane on an already crowded motorway that enabled some people to bypass others to access care.

'It's convenient for those people who can afford the IT equipment, have the connectivity, have the eyesight and the dexterity, the IT skills and the IT confidence,' she said. 'It's certainly not a bypass route for all those with the most need. These people wait longer in the jam.'

She added: 'Our clinical time is finite - it must be used to add the most value to our patients and our communities to those with the most need. We're good at flexing and being innovative to meet local needs. We should be supported to build on this and given the autonomy to work towards equity for our patients, not hindered by unevaluated initiatives and perverse political incentives that demonstrate a woeful lack of consideration of the diverse needs of our communities.'

Increase in workload

Dr Zishan Syed from Kent LMC said that GPs needed 'real action to stop this nightmare' of online consultations.

'Locally to practices have switched off their electronic consulting completely stating that it's not fit for purpose,' he said. 'Other practices are so overwhelmed that some people are considering giving up GP partnership altogether because of the infinite demands that this technology is generating.'

Responding to the debate, Dr Anu Rao from GPC England said that having 'centrally mandated requirements without local autonomy doesn't work'.

She said GPs needed to work with their patients to decide what consultation method was best for them based on their needs. Dr Rao said that GPs needed evidence to help them do this, adding that the BMA was currently planning a programme of work to better understand the impact of digital consultations in primary care.

The motion in full

That conference believes that GP practices should decide how they can provide the best service to their patients; the introduction of online consulting was inadequately planned and resourced, and:
(i) insists on proper evaluation of the workload, safety, cost and impact on health inequalities of these before any further roll out is implemented
(ii) directs GPC England to negotiate regulations that enshrine the rights of practices to choose which systems they use for their population
(iii) believes that online consulting should not be a part of the GMS contract
(iv) calls for the removal of all mandates and incentives regarding online consultations
(v) is concerned that the 21/22 PCN DES includes a target for number of e-consultations per practice and calls for this target should be scrapped.

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