How to embrace online consultation — a guide for GP practices that guarantees success
Updated: Feb 12, 2021
A reframe that will turn all practice change challenges into wins
The digital age has brought us amazing technological advances, with undeniable benefit and appeal.
There is great hope that this benefit and appeal will be experienced in healthcare, impacting positively on patient care, staff workload and the overall sustainability of the NHS.
This is yet to be proven.
In the context of no absolute proof, GP practices are now contracted to offer digital-first options to patients in terms of how they access services — with the expectation being that this will expand over time to include new ways of data analysis, healthcare pathway design and even treatment provision.
The largest and most challenging system revision(s) for Primary Care in living memory.
The response to these expectations is mixed, with handfuls of practices embracing the challenge and pushing hard to innovate and implement technology at pace. These are often heralded as flagships for the nation and marketed as a future ideal for all.
The reality for most is that these changes have arrived at the most challenging period for Primary Care. The sector as a whole is reporting high rates of staff burnout, unmet demand, staff retention/recruitment issues, and low resource. The task of practice managers and partnership boards being primarily about how to meet demand and keep afloat, in the context of what feels like a burning platform.
The problem is easy to agree on. How to deliver best practice in this context, without burning out or falling apart.
The solution is less clear.
One solution, now contracted in Primary Care services, is the use of online consultation technologies to support patient access and triaging services — based on the rationale that patient need will be better met with less time spent by high demand clinicians dealing with low complex issues. The evidence is light that this is achievable, and the sector is aware of this… which has created a range of negative responses for some teams including disinterest, fear, and anger. This is understandable and should not be ignored.
Online consultation is not for the faint of heart. It is a whole system revision and requires a shift in working for clinical teams, trusting a remote triage model rather than one that requires person-to-person contact with every patient. It requires changes in clinical practice and the models of access to services — a quality improvement challenge that is complex and beyond what many practices have experienced. There is a lack of trust in this approach, in response to how little evidence there is to suggest that this revision is the solution to the problem.
We regularly meet resistance in teams who are being pushed to implement online consultation. There are shared concerns:
will uncapped access lead to increased demand, rather than less demand?
will remote closing create increased risks for patient care?
will digital triage lead to less opportunity to spot other problems patients have, rather than those reported?
will access be equal to all patients (e.g. older patients, those with disabilities)?
will the use of eHubs reduce continuity of care?