31 May It’s time to embrace online consultations
As part of its five-year transformation plan, GP Forward View, NHS England has announced £45m over the next three years to help GP practices purchase online consultation systems. This is great news for those doctors embracing online consultation but worrying for the ‘traditionalists’.
Many of these traditionalists argue that patients don’t understand, can’t use and don’t want online consultations. But in my practice in London, where I have been a GP for over a decade, we have been using online consulting effectively for four years, across 15 surgeries, and most patients have got to grips with it very quickly.
While I accept that online consulting isn’t for everyone patients are usually very adaptable, especially if it means they don’t have to phone repeatedly or wait weeks for an appointment. Some of those patients who use our online consultation tool are in their 80s, most are 40-60.
We have an online consulting system which allows patients to interact with our surgeries on 80 common conditions including UTIs, earache and contraception, using an online questionnaire. Patients aren’t dealt with by nameless GPs with no access to their medical records, they are looked after online by their own practice within 24 hours of getting in touch and are happy with the results.
In my experience, it’s not the patients that are the barrier. The real challenge is to get GPs to open their minds to new approaches that can benefit their patients and their practices.
Face to face consultation has become embedded in GP culture as the gold standard in care. Asking doctors to leave this norm and enter a commissioning landscape for technology enabled care with complicated service specifications and alien bits of kit is not easy, but if NHS England wants to transform primary care by 2021 they need to understand the concerns of these GPs and get a grip on change management.
Case studies preach to the converted but do little to change the mindsets of those who think that new technology is best left to the next generation. Hard cash has its attractions but it can’t always penetrate the wall of fear, and can easily lose its way in a digital health procurement landscape with landmines of confusion about what to buy, how to buy, from whom and from where.
Many GP practices and CCGs buy telehealth equipment separately, directly from suppliers, in low volumes and sometimes with little competitive process. A large proportion opt for contracts lasting seven years, meaning they can’t benefit from the latest technological advancements.
Access to technology enabled care varies widely. A recent report on digital health in the UK indicates that 108 out of 176 CCGs were commissioning telehealth services in 2013/14, expecting to spend around £15.2 million in total in this period. However, 28% of these reported problems with implementation including issues with suppliers and lack of end-user adoption. These problems resulted in far less patients accessing telehealth than anticipated.
The industry body for technology enabled care, TSA, is working with procurement specialist Inprova to tackle some of these problems, helping CCGs and GP surgeries to procure a wide range of health technologies in line with procurement regulations and at competitive prices.
This is important work, but we also need to tackle the issue of end-user adoption – why so many GPs just aren’t using the kit. How can we convince them of the benefits?
My practice’s own research shows clear outcomes. Three in 10 patients have been diverted from the consulting room via online consulting, freeing up time for 20-30 minute appointments with patients who have more complex conditions. Many minor conditions are now managed online and people needing routine or admin tasks – a repeat prescription or a blood test for example – don’t need to see a GP. Some patients who once came to see us 12 times a year now come just eight times a year.
Instead of a typical morning surgery including 18 face to face consultations, three or four phone calls and lots of admin, we now look after 12 patients face to face and three or four via calls and online. We can do three e-consults in the time it takes to do one face to face appointment.
More people with mental health issues such as anxiety and depression are also coming to us via online consulting. These are patients who would previously have been too intimidated to walk through the surgery door.
General practice is never going to get a huge pot of gold and we can’t wait another 10-15 years for much needed changes to take hold. Well developed, appropriately commissioned and procured, user friendly online consulting tools can make a difference. But without investment in behaviour change, technology enabled care will continue to be seen as the enemy at the door.
Murray Ellender qualified from the University of London in 1999 and trained as an A&E doctor before starting his career in general practice. He joined the Hurley Group in 2006, and leads on both digital and urgent care issues for the group. He now spends most of his time heading up www.econsult.net and helping to transform general practice with technology. He also sits on various urgent care boards, including the Clinical Leadership Group for Urgent & Emergency Care, NHSE (London).