What makes patients use online consultations?

Problem

In response to a perceived gap between patient demand and GP capacity, attention has focussed on the potential of online consultations to improve productivity. NHS England has allocated £45m to the technology, although its own evaluation of GP Access Fund pilots showed very low patient take up, and the simpler idea of online booking has resulted in only 4% of appointments booked online after 5 years of effort. So the problem is to understand what might entice patients to use online consultations, in which so much hope has been placed.

Approach

A retrospective study of 38 GP practices, diverse in the UK in terms of size, location and deprivation, comparing the effect of different levels and strategies used to encourage patient usage.Analysis of usage by patient age & sex, by time (enabling interrupted time series analysis and by week/day/hour demand pattern), for a total of 37,000 patient episodes.Analysis of type of demand, medical or other, and clinical symptoms. Analysis of patient feedback (2,400 free text comments left by patient users) to understand themes driving use.

Findings

Usage is well spread across all age bands from 0 to 95+, although varies in magnitude from peaks among young adults, and on behalf of their young children, to lower levels among the elderly.Usage can be high in any location or socioeconomic group, with up to 20% of demand in rural communities, higher in some urban groups.The primary driver, for a given software platform, is the nature, timing and level of encouragement given by the GP practice, specifically a clear message at the time of patient seeking help, and a simple route to meeting their need.

Consequences

In order to fulfill the hype, I mean promise, of online consultations making a significant difference to GP workload, a high rate of patient use is a necessity. If an online entry point makes say 20% saving of GP time, but only 5% of demand arrives online, the result would be a barely measurable 1% saving. If 50% of demand arrives online, the same relative saving in time would mean a 10% overall saving. Practical advice on how to move patients to online consultations, based on the evidence presented in this study, can therefore have highly significant consequences for the return on investment made in online consultations and in overall NHS value for money.(note: the word "Consequenses" on this box is misspelled)