Online Consulting - we need to be interested

GP Online has further fuelled the growing debate around online and video consultations today, publishing results of a poll that suggests more than half of practices in England have “no interest” in providing online consultations (https://www.gponline.com/practices-england-not-want-provide-online-consultations/article/1454320).

When put in context of YouGov research that shows more than six out of ten patients would rather consult online than wait nearly two weeks for a face to face appointment[1], there is an argument that says primary care must rethink its priorities. Harnessing technology and digital innovation is critical to the future of the NHS. Digital is disrupting every aspect of our lives. From banking and shopping online to Uber and Airbnb, technology has created a new normal. And, as the YouGov research suggests, people will expect access to digital healthcare advice to become another new normal.

GP Online previously reported recent data provided by GP at Hand that reveals more than 10,000 patients aged between 20 and 44 have signed up to the new video consultation service. Debate will no doubt continue across primary care as to whether the service is “cherry picking” a young and largely healthy commuter workforce, but the numbers nevertheless confirm a public hunger for new ways of doing. 

A generation used to everything at a press of a button or swipe of a screen will increasingly resist a service that is so firmly shaped around the needs and interests of providers rather than their patients. Why take precious time off work to see the doctor when you can e instead? The GP consulting model is beyond pensionable age and yet has barely changed since 1948; while the pressure on both patients and doctors has changed beyond recognition. Our bad if we persist in a “no interest” approach to what people actually want and bury our heads in an analogue sand.

In the early noughties, the emerging internet was a source of immense frustration. Half an hour to download a page of information through dial-up broadband made tech providers’ pioneering claims laughable. That we might one day bank, order groceries or book a holiday online – or even, imagine, via our phones – were shrugged off as absurd, impractical and dangerous flights of fancy. And yet, thanks to advancing technology, levels of banking security are higher than they have ever been, and the idea that we might queue to cash a cheque in the days of contactless is clearly absurd.

As both a practising GP and a founder of eConsult, the most widely used digital triage tool in the NHS, I interact with patients and with NHS GPs all over the country. My conversations with those GPs don’t reflect the results of this poll. Most simply want to provide the best possible patient care but are increasingly overwhelmed by demand, expectation and dwindling resource. They recognise the answer isn’t just about more money, but increasingly about new ways of doing things; and they like eConsult because it maintains the direct connection between patients and their own GP. But, unsurprisingly, as evidence-trained doctors their instinct is to seek proof of efficacy and currently they have only one study, now considerably out of date, to turn to. 

Nevertheless, evidence is important, and as more and more practices jump online, so we have the opportunity to build data sets that allow us to continuously improve and transform a platform developed by practising GPs to be one part of a solution to transform the NHS from within. Evaluation is ongoing and the emerging quantitative data firmly indicates that econsulting will be a new normal far more quickly than is envisaged today. In the meantime, recent qualitative feedback from an initially cynical GP and CCG chair, is increasingly our ‘normal’.

This GP was pretty reluctant to go live until eConsult met his quite specific operational requirements. His practice went live at the end of November and since then has leapt to the top of the CCG leaderboard in terms of utilisation in the weeks since launching. He was vocal in his scepticism about online consulting before he started but is now totally convinced that it works. His practice has generated 185 online consults in the first four weeks, a channel shift he is rightly proud of.

It has made duty doctor sessions much more bearable – dealing with the same number of patients, but half now coming in online – with much richer information, so not all have to be called back. All his GPs who do duty doctor sessions are positive about it and regret their initial lack of interest.

Reflecting on the days of dial-up broadband, it seems to me that all transformational change requires a leap of faith at some point. Like it or not, the digital health genie is firmly out of the bottle.

[1] https://www.salixandco.com/new/new-news/client-news/patients-open-consulting-gp-online/