A reduction of practice workloads and more effective delivery are a central part of what will make general practice sustainable, and the theories and strategies around this are key to the future of quality primary care delivery. One rapidly developing aspect of this has been the creation and refinement of online consultation tools, patients telling their practice about a query, symptom or issue through a patient portal of some sort.
The impact is that patients who are suitable for this type if consultation are managed with online pathways before the need to have valuable face to face GP consultation time. A patient online query can result in a response, a prescription, a call back or a face to face appointment. Given the inherent characteristic of this interaction between the patient and the practice, each action depends on an initial assessment of need and therefore it should reduce workload through more effective scheduling of GP appointments.
If operated correctly it should also improve the time the higher priority patients get with their GP, as an appointment is now only one of a number of options available. Often these tools can promote patient self-care and increased use of other services such as the community pharmacy, 111 services or the plethora of specific healthcare and health monitoring apps available further reducing demand on GP practices.
Early signs are that these systems are proving popular with patients who they are suitable for, who get a faster resolution to their issue. They also have potential benefits for the practices themselves which are managing work load, healthcare resolution and improved morale, as both patients and GPs can be more satisfied with the outcome. However, this is with the caveat that there continues to be enough patient uptake for such a system and that practices are justified in investing in such a system with all the additional infrastructure required to access it.
There is definitely an appetite from within the NHS to implement online consultation processes as part of NHS England’s digital transformation strategy. In line with this the General Practice Forward View national GP development programme gives support for groups of practices to implement changes, releasing time, improving patient care through finding and implementing new ways of working of which online consultation is a key part.
Over 300 practices are already offering online consultations to more than three million patients and there is £45m set aside to fund online consultation systems in a concerted effort to enable GP practices to make the best use of their limited time and resource. Taking physiotherapy as an example, more than one in five GP consultations are for patients with musculoskeletal (MSK) problems. (Source for this statistic: RCGP) It is common for patients to have six to 12 weeks waiting time for traditional MSK services which are commonly delivered in a disjointed and multi-provider landscape with variable outcomes. Early diagnosis is key and is a great example of where diagnosis and self-management can be prescribed via an initial online assessment or telephone management system. There are already numerous examples nationally of this practice significantly reducing the need to see a GP.
Online consultation systems highlight how systems that are aimed specifically at patient care can dove tail with initiatives that are more aimed at the wider use of online technology to support the back office systems, contract negotiations and operation with commissioners and the overall structure of primary care organisations. Where once the operation of the clinical side of GP practices might have been sacrosanct; now it is acknowledged and accepted that new ways of working need to be found on both the administrative and clinical sides of GP practice operation.
Addressing inefficiency where ever it exists will free up resource that will ultimately have a positive impact on the quality of patient care within a GP practice. With more focus on the business of primary care and the improvement through technology of patient care, the ultimate beneficiary will be the patient. Addressing bottle necks in the system such as high number of phone calls to practices, a crowded waiting room and spike in GP appointments as well as the more mundane back room efficiencies will lead to improved morale within the practice from all the staff, both clinical and administrative, and once again will indirectly and directly positively impact on the patient and their outcomes.