Centre for Academic Primary Care

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E-consult

Before deciding on introducing an e-consultation service then you may wish to think about:

  • What exactly are you trying to achieve through using an alternative to a face-to-face consultation? 
  • An alternative to a face-to-face consultation is a learning process, it might take time to embed and could develop organically which might include finding more uses than originally expected.
  • Beware that commercial interests are at play and people are selling products which have not necessarily be independently evaluated.
  • How will you make your patients aware of the availability of e-consults?
  • Do you have clear agreed protocols so that all contacts are responded to in a timely manner?
  • How will you record e-consultations in the medical records?

Before introducing an e-consult as an alternative to a face to face consultation then you may wish to think about the following:

The choice of type of an alternative to a face-to-face consultation is dependent on your rationale for using an alternative to a face-to-face consultation. Is it for convenience for patients, improved patient access or to manage demand? It is also dependent on ensuring that the alternative to a face-to-face consultation(s) you have decided to introduce are suitable for your practice and its demographics. More information on who it is for and why can be found here. 

Practice costs 

  • What will be the initial financial outlay?
  • Do you have sufficient infrastructure?
  • Will any additional calls be costed? (To call patients back)
  • Is this commercially driven? – Will you be using a commercial product?
  • Is this a funded pilot? What will you do once the pilot is finished?
  • Will the introduction require further staff training?
  • Will you require funding to inform patients of the changes?
  • Do you have clear protocols and operating procedures for all staff so that incoming patient requests are dealt with in a reliable and timely manner?

Patient related

  • Are there certain patient groups that will be disadvantaged? More information on who it is for can be found here.
  • How will you inform patients of the changes? – Possible options are; letters to patients, flyers, banners in the practice, social media or word of mouth.
  • What do your patients feel about e-consulting? – Speaking to local representatives is useful, for example via a patient participation group. 

Benefits and Concerns 

  • Are you anticipating that an e-consult will be shorter/quicker than a face to face consultation? – How will you know?
  • The proportion of e-consults that are followed by a face to face or telephone consultation is crucial to understanding the efficiency of the system – you can audit this.
  • What might be lost? – Accurate history, non-verbal cues, patient/doctor relationship
  • What might be gained? – Flexible working, more control over workload, patients feeling more relaxed, further continuity of care, accessing patients who are otherwise unable to attend the practice.
  • What will you do if the technology fails? – Produce detailed protocols for use.
  • How will you include the contents of the consultation in the patient records – Is it an integrated system (recommended where possible), or will it be in a separate attached document?
  • How will you ensure that this does not become additional or hidden work? – Ensure scheduling and recording of the alternative to a face-to-face consultation.
  • How many patients need to use the system in order for it to be worth the cost and effort? 

Safety and Security 

  • How do you know the identity of the person you are communicating with, or who else might see your communication?
  • Have you considered how you will ensure that patient confidentiality is maintained?
  • Are there conditions that should not be managed by e-consult? Is this clearly recorded and communicated to patients and staff? 

We have provided some useful guidance below:

A list of companies that offer support for telephone consultations can be found here:

Our pilot of [e-consultation system] is about to come to an end. We were given this on free trial basis to see what we, and our patients would make of it. Patient satisfaction has been good and we're pretty sold on the concept.

GP from inner-city Practice E

I think one of the things that they said at the initial presentation was that you would perhaps deal with two or three interventions in the space of seeing a patient.

GP from inner-city practice A

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