Evaluating an online consultation system for use in GP practices
In collaboration with OneCare, a general practice consortium, CLAHRC West staff designed and undertook a mixed-methods evaluation of a pilot implementation of online consultations (eConsult) in 36 general practices across Bristol, South Gloucestershire and North Somerset. The research showed that the system did not produce expected efficiencies in GP workload or cost-savings, with 70% of online consultations resulting in either a face-to-face consultation or a telephone call from a GP. OneCare developed a business case from our findings to help practices decide whether to continue eConsult, using their own funds and the majority did not continue beyond the pilot period. Findings have been presented locally and nationally and three peer-reviewed papers have been published from the study (2 x BMJOpen and British Journal of General Practice) which gained good media coverage upon their release.
This research ensured that general practices and commissioners understood the likely consequences of introducing e-consultations. It has prevented additional workload being generated in primary care and enabled practices and policy makers to delay investment until software developers refine the system and efficiencies are shown. The developers have made changes to the system based on the findings.
CLAHRC West has produced guidance to improve the implementation of online systems that recommends that practices consider marketing online systems to encourage patients to use such systems for routine enquiries or follow-up advice and discourage use for more complex enquiries where a face-to-face appointment will probably be needed.
CLAHRC West are working with the RCGP to produce e-learning guidance on the implementation of online systems and with NHS England to produce national guidance as part of the General Practice Forward View online consultation system fund
Contribution of CLAHRC West
CLAHRC West provided leadership in designing the research and essential research expertise in conducting the evaluation. They have also led the wider implementation of the findings by drafting guidance on improving the implementation of online consultation systems and are currently working with NHS England and the Royal College of General Practitioners (RCGP) to implement these. In addition CLAHRC West developed the findings into a CLAHRC BITE and policy briefing note that has been distributed to MPs, policy makers at the BMA, RCGP and NHS England, CCGs, and - in collaboration with RCGP - to over 1000 GP practices nationally.
What happened next?
The research findings have been included in an NHS England report ‘Managing Access in English General Practices’, RCGP guidance ‘Online consultations in general practice’ for patients, GP practices and STP/CCGs considering using online services, and a recent BMJ editorial. CLAHRC West are working with the RCGP to produce e-learning guidance on the implementation of online systems and with NHS England to produce national guidance as part of the General Practice Forward View online consultation system fund. This work has led to a successful NIHR School for Primary Care Research grant to investigate the unintended consequences of the use of digital health tools in primary care.
A CLAHRC BITE has been produced by CLAHRC West. Read the research summary here.