The impact of online consultations in primary care: mixed-methods findings of a pilot study from thirty six general practices.

Problem

As demand on primary care services continues to rise so does the political drive to improve access for patients and practice efficiency. Online consultations may help to increase patient access to primary care, while potentially reducing GP workload from face to face consultations. We present a mixed methods evaluation of the pilot implementation of eConsult (formerly WebGP), a web-based platform allowing patients to access online advice and care via their own GP practice website.

Approach

Thirty six primary care practices piloted the eConsult platform between April 2015 and June 2016. Quantitative data were available from: website usage statistics and patient survey data from 36 practices and health care resource use data from patients’ electronic medical records from 8 practices. We summarise the number and type of patient using the online platform, when they accessed it, for what reason and the NHS costs. Qualitative data were available from patient survey data from 36 practices and semi-structured interviews conducted with clinical and non-clinical staff from a purposeful sample of 6 practices. Interviews were audio recorded, transcribed, imported into NVivo 10 and analysed thematically.

Findings

The evaluation utilised (a) website usage statistics from 35,981 eConsultations, (b) patient survey data for 756 eConsultations, (c) health care resource use data for 485 eConsultations and (d) qualitative interviews with 23 practice staff. Patient use of eConsult was low and the majority of eConsultations were submitted during weekdays and surgery opening hours. Users were more likely to be female and aged 25-44 years. The most common reason for an eConsultation was for administrative reasons (e.g. requesting fit notes, repeat prescriptions) followed by infections and immunological issues and musculoskeletal issues. 38% of eConsultations resulted in a face to face consultation and a further 32% were telephoned by a clinician. The majority of patients reported that they valued eConsult system. However, qualitative data highlighted tension between patients and practices expectations of the eConsultat platform. Clinicians reported eConsult working best for simple and routine enquiries that they could respond to without the need for a face-to-face or telephone follow up. When a complex set of symptoms or new symptoms were presented clinicians felt it was best to arrange a face-to-face consultation. The lack of integration of the eConsult platform with existing practice IT systems created challenges in work flow within practices

Consequences

Unless usage of online platforms increases and integration with IT systems improved, online consultation systems are not likely to have any notable impact on patient waiting times and staff workload and may add to practice workload. While our results indicate that there is an appetite amongst patients and practices to engage with digital communication, the study also highlights the challenges of remote consultations which lacks the facility for real time interactions.