- 74% of eConsults did not need a face-to-face appointment
- 9% of eConsults resulted in telephone consultation
- 61% of eConsults responded to on the same working day
“That’s why we are using it – giving patients better access to the healthcare they need in ways that suit their lifestyle and preferences.”
Old Machar Medical Practice is one of the largest in Scotland, with just under 18,000 patients. When the practice was approached by the Scottish government to take part in a pilot study on electronic consultation, GP Partner David Cooper and his colleagues were keen to see how it would help patients.
The practice agreed to participate in a three-year trial, and implemented online consulting solution eConsult in August 2016. “One of the aims of the pilot is to enable thorough academic evaluation, funded by Scottish Government, looking at areas such as cost-effectiveness and patient satisfaction,” explains David. “Eleven practices are taking part: urban, suburban, rural and single practice – a broad mix. We have a telephone conference once a month to discuss how it’s going and share ideas.”
With two branches – one in Eastern Aberdeen, an area with high levels of deprivation, and the other in the more affluent north suburb of the city – Old Machar has a mixed demographic that provides a good sample for the trial.
Implementation was fast and straightforward, with no technical barriers and a concerted marketing effort helping raise patient awareness. “We were lucky enough to have marketing materials supplied to us as part of the pilot – large and small posters, leaflets etc. – and we have had eConsult information on our website since we went live,” says David. “We also sent texts to all patients over the age of 18 to alert them to the availability of the new service, and lately we’ve started advertising in local pharmacies too.”
Patient uptake has been good: “We didn’t want to force people to use it. Our approach was more one of self-selection: people will use the system if they feel it’s right for them – but lots of patients do seem to like it.” Outcomes also reflect the success of the pilot so far. “We’ve found that a lot of patients’ problems turn out to be fixable without an appointment. We probably only have to see about 20% of the patients who complete an eConsult.”
We probably only have to see about 20% of the patients who complete an eConsult.”
The system helps Old Machar’s GPs too, because when they do carry out a face-to-face consultation, they have all the information they need before patients walk in the door. “It’s amazing how the system has supported a new approach to consulting, and one that’s right for the way we live now,” says David. “There will always be some GPs who believe that they need to see every patient who contacts us with a health issue, but actually that isn’t always the best way for patients or GPs.”
By way of illustration, David cites the cases of people with conditions that they might find embarrassing to talk about face-to-face: “Sometimes people don’t want to come into the surgery – they find it easier to write their symptoms down.” Equally, some people don’t find it easy to get to the practice if they’re working long hours. “It’s good for patients who have mental health issues too, because they can write down how they’re feeling when they are feeling it. The system provides another way of communicating with the practice. That’s why we are using it – giving patients better access to the healthcare they need in ways that suit their lifestyle and preferences.”
Having 24-hour access to eConsult helps several groups of patients – for example, students (who often seem to keep unusual hours!) and people who work night shifts. “Some eConsults come in at 2.30 and 3.00 in the morning,” explains David.
“People do it when it works for them.”
Asked whether eConsult has simply opened up another route into the practice, rather than helping find a better, more efficient solution to consultation, David feels the latter is certainly true: “At the end of the day, those people are going to ask those questions at some point. All we’re doing is offering them an easier way.”
Within the practice, eConsult has helped GPs, who have better information at their fingertips and can offer patients a faster, more efficient service. Receptionists like it too: “Our reception staff find it helpful to be able to encourage people to use eConsult, rather than just telling them we don’t have any appointments available.”
When thinking about the advice he would give to other practices considering eConsult, David says it’s important to know how the process is going to work for your practice before you start. “There needs to be someone processing the eConsults, forwarding them, making sure you get back to people by the end of the next working day.” He also believes there’s an opportunity to focus your marketing according to demographics and patient behaviour: “Look specifically at your patient population and consider how they’re likely to respond.”
He cautions against preconceptions, though: “Although our eConsult users are predominantly 18 to 35-year-olds, we do have a significant number of silver surfers using the system. The oldest user is 89.”
Evaluation and feedback are important for any implementation, and particularly for a pilot such as this. The first three months’ statistics have just been made available, and Old Machar will be feeding back to the Scottish government: “We’ll be looking at issues around how many times we have to phone patients after they complete an eConsult, how much time receptionists spend with each one, etc. I think it will be very useful.”
Top-line statistics are encouraging:
- 74% of patients did not need a face-to-face appointment
- 9% of eConsults resulted in telephone consultation
- more than 61% responded to on the same working day
Patient satisfaction should be high, which was the main driver for Old Machar in implementing eConsult as part of the trial.
David Cooper is confident that embracing some of the new eConsult developments will further enhance patients’ experience: “It will be great to offer the mobile version and the various apps for managing long term conditions like hypertension, and we’re currently looking at that too” he concludes.