"A surprising gleam at the end of what often feels like a long and very dark tunnel"
Recent debate on the impact and efficacy of phone, video and online consulting has been largely driven by two studies completed in June and March 2016. Academic studies tend, by their very nature, to be outdated by the time they are published, and this is especially true in a fast-paced technology environment.
“Online GP consultation systems as they currently stand are unlikely to take the pressure off GPs and practices” ran the Centre for Academic Primary Care’s (CAPC) press release to mark its first study into online consulting published late last year (November 7, 2017). The study, which focused almost exclusively on eConsult, was undertaken during a period of early mobilisation across One Care in Bristol between April 2015 and June 2016.
The study was made available to eConsult a year before publication, and outlined productive and useful recommendations, which we have since adopted. As a result, we saw a doubling in the use of econsultations across the country from 2016 to 2017, and a fourfold increase across a single London CCG in 2017. However, the case remains that a study instigated nearly three years ago cannot, by definition, reflect a situation that is ‘current’.
Now, another study by the CAPC, led by researchers at Bristol University, suggests that “The realities of implementing alternatives to face-to-face GP consultations, such as telephone, email, online and video consultations, mean that hoped-for reductions in GP workload and increases in available appointments for patients might not be realised.”
This study was undertaken between April 2015 and March 2016, a time lapse between study end and study publication of almost two years. Academic studies are important but we need more debate on whether they are the most effective way to evaluate rapidly evolving technologies. Because so few studies are available, and there remains a cohort of sceptical GPs, those that are available tend to be overplayed and given a credence that can be misleading. Until new academic data is available, we continue to collect and analyse data on a weekly basis, listen to clinical and patient feedback and constantly refine the eConsult platform for ease of use, efficacy and, most important of all, clinical safety.
The second CAPC study points to problematic Skype and video consultations and suggests that policy-driven, top-down approaches using financial incentives as a way of encouraging adoption of alternative consultation methods is not the best way forward, which reflects our own experience. Generally speaking, econsultations (by which I mean online contact with a patient’s own GP via our digital triage platform rather than a call centre video led consultation model) work best, particularly when properly implemented, and with engaged practices where we continue to interact on a regular basis.
Even so, front line attitudes are changing. In Bexley, where eConsult is powering NHS England’s NHS Online pilot, practices are required to adopt eConsult’s digital platform so they are fully integrated with the app. Influenced by media coverage, Dr Sid Deshmukh, chair of NHS Bexley CCG and lead GP and partner at Sidcup Medical Centre, was a vocal detractor, and is now an evangelical advocate.
“I was very sceptical about online consultations before we started using them in our practice. Ours is powered by eConsult and contrary to my expectations, I am totally convinced they work - for doctors as well as patients.
Our practice only went live with eConsult at the end of November 2017, but we’re already seeing the benefits. The duty doctors have nothing but positive things to say. It’s made their sessions much more bearable - dealing with the same number of patients, but half now coming in online with much richer information, so far fewer having to be called back.
I find myself proud that around 40% of all eConsults in Bexley are now taking place in our practice – a complete channel shift. So, to all the sceptic GPs out there, I’d say try it – it’s proving to be a surprising gleam at the end of what often feels like a long and very dark tunnel.”
That we can magic up 5,000 new NHS GPs in the next couple of years, while new private technology-driven models are spending millions to lure them away, is a fairy tale. Harnessing technology and digital innovation from within is critical to the future of the NHS and is ‘currently’ our only real option.