FAQs - eConsult

What is eConsult?

eConsult is a platform that gathers structured histories from a patient. These eConsult reports are then reviewed by a clinician at the patient’s own primary care practice in an asynchronous environment, if the request requires clinical advice. Administrative requests can be dealt with by administrative staff or in combination with clinical staff, as relevant.

Patients are also offered options for self-help and signposting to other local and national services, moving demand into more appropriate environments.

Who can access eConsult?

eConsults can be adult (over the age of 18 years) or paediatric (between 6 months but under 18 years). Paediatric eConsults can be submitted by a parent or guardian, or by the patient if they are between 16 and 18 years of age.

Any patient who uses the eConsult service must be registered at the practice where they are submitting an eConsult.

What are the benefits of eConsult for my practice?

eConsult is adaptable for each practice, depending on how you want to use it. If implemented and used well eConsult can:

Cut consultation time – the average eConsult is closed with 2-3 minutes
70% of eConsults are closed without the need for a face-to-face appointment
Make better use of other primary care services – not all eConsults require GP review, so you can allocate work based on need and expertise
Standardised histories taken from all patients
Help improve the care you provide for your patients – prioritise patients in need
Improve patient access – let patients tell you their symptoms when convenient
Reduced telephone call volume and queues

Will this add to practice workload?

No – patients should be encouraged to ask for advice (clinical or administrative) through eConsult. This will reduce your call volumes, call backs and the number of patients attending the practice. Your admin staff can then focus on workflowing eConsults and actioning admin requests, leaving your clinical staff to action clinical eConsults.

Some practices find eConsult usage is low to start with – this is why marketing the service to patients with every interaction (both with admin and clinical staff) is important. Once the practice and patients are comfortable with the service, the number of eConsults the practice receives will rise.

If you have thought about your workflow well and staff are trained and practiced in using eConsult, increasing numbers of eConsults should not add to practice workload – it will just be a different way for patients to ask for advice.

We strongly recommend clinical staff replace some normal slots with eConsult processing time daily – time spent eConsults is still considered as an appointment. Administrative staff will find that time spent fielding queries on the phone is reduced, and instead they are actioning administrative eConsults or other non-clinical queries.

What changes do we need to make as a practice?

How you use eConsult depends on how much value you want to get from the platform. We advise you spend no more than 4 weeks on the implementation process, although you can start before then if your staff are all trained and prepared.

To get the most value – in terms of money and experience for patients and staff – we strongly recommend you think about maximising your workflow, supported by eConsult. We also recommend clinicians build time into their normal working day to review eConsults – they are not additional work, they are an alternative way for patients to seek advice for their problems.

If you want to get more familiar with how you use eConsult before changing your workflow, we suggest you advertise eConsult heavily to patients as an additional channel for contacting the practice. As patients and practice staff become more familiar with the system, you can then speak to your eConsult Operations Executive for advice on which workflow could help you to maximise its use and value.

Have a look at some of the workflows that existing practices use and the benefits they have seen.

What clinical system do I need to use eConsult?

eConsult does not depend on practices using specific clinical systems – the eConsult report is sent to your designated practice email inbox as a PDF. This can then be integrated into patient notes, regardless of the system used.

You can see our guidance on how to integrate eConsults with different clinical systems here

How much time does it take to use eConsult?

One of the key benefits of eConsult is that the patient’s history is taken in their own time. This is then sent to you in a standardised and clinically robust PDF form which is no longer than two sides of A4.

It may take you a few minutes to familiarise yourself with the information each report provides, but the more you do, the faster you will be at processing them. To start with, you may take around 3 minutes to process and eConsult, but some of our experienced users do these in around a minute. That means you could action more than three eConsults in the time it takes to do a normal 10 minute appointment.

How long patients take to complete an eConsult may depend on how comfortable they are using their device of preference, and how detailed they are in their free-text responses. We suggest your practice considers alternative options for those not comfortable or willing to consult online – for example, one of the admin team could help them to complete an eConsult over the phone.

Conditions available have been carefully considered, and individual conditions cannot be turned off for your practice. You can opt in or out of paediatric eConsults at any time.

What should you do if the patient is not registered at the practice?

If the patient is not registered with your practice, please contact the patient on the telephone number they provide or via a direct message. Advise the patient to contact their own GP, or visit www.nhs.uk to find the nearest walk-in centre or GP Practice (if they are not already registered). You may wish to ask the patient to register at your practice if they are within your catchment area.

How can we get paediatric eConsults?

Paediatric conditions are available for all practices at no additional cost.

Paediatric eConsults are available for patients aged 6 months up to 18 years, and can be submitted by a parent or guardian on their behalf. Patients ages 16 to 18 are also able to submit eConsults directly. It is not possible for parents to submit eConsults for patients below the age of 6 months.

If your practice signed up before August 2018 or you do not want this service, you will be required to opt in or out by contacting your eConsult Operations Executive.

The Clinical Negligence Scheme for General Practice (CNSGP) covers activities which are commissioned under a GMS, PMS or APMS contract (or related enhanced primary care elements under an NHS Standard Contract), and where a provider provides services directly or under a sub-contract. The scheme coverage extends to nurses/ANPs and other practice staff who are carrying out activities in connection with the delivery of primary medical services. The location of the services being provided and whether they are digital or face-to-face will not affect the cover. The services/consultations must be being provided via a GMS/PMS/APMS contract and the consultations themselves must be connected to the diagnosis, care or treatment of a patient.

How do I process eConsults?

eConsults can be submitted for clinical or administrative requests. We provide templates for over 100 clinical conditions and 5 administrative requests. eConsult reports are no longer than two sides of A4 and are delivered into a dedicated email inbox as a PDF, ready for integrating with your clinical system.

Clinical eConsults should only be actioned by a clinical staff member – the speciality of the staff member may depend on the query and the background of staff in the practice. eConsults can be actioned by non-GP clinical staff members if appropriate.

Nurse Practitioners and other Allied Health Professionals can process eConsults assuming that the eConsults they deal with fall within their level of expertise and qualifications (scope of practice). The practice will need to ensure that non-GP clinical staff have the appropriate insurance coverage and are working to the same patient presumption as the GPs. They should seek guidance from a GP if at anytime they are unsure as to how they should deal with an eConsult.

Admin eConsults can be actioned by both admin and clinical staff, depending on the request.

Our Medical Director has created some videos showing how he might process different eConsults. Click the button below to access these:

Training

How do I process paediatric eConsults?

Historically, guidance from the Medical Defence Organisations states that all paediatric eConsults require a phone call as a minimum to close the encounter. This ensures that the clinician is satisfied with the history provided by the parent or guardian, enabling an informed management decision about the child. Some cases may also require a face to face appointment following review of the submitted eConsult.

The one-way messaging facility cannot be used to close paediatric eConsults, and so is disabled. If your practice has an extended response time beyond ‘the end of the next working day’ then due to clinical risk paediatric eConsults are not available.

Some paediatric templates allow patients (16-18 year olds), parents or guardians to upload photos to assist the clinician in understanding the patient’s request for advice. We ask the user for consent at the point of uploading. All photo upload questions are optional and do not need to be completed by the user.

Under data protection law, your practice is the Data Controller, therefore any images received and uploaded into the clinical record will fall under the practice information governance and GDPR policies. eConsult doesn’t store or retain any of these images.

How do I respond to eConsults?

We recommend that eConsults are responded to by the end of the next working day. This does not mean you need to have resolved the patient’s query. We find patients are most dissatisfied when they do not hear back from the practice within the stated time frame.

Please consider the most appropriate form of communication when corresponding with a patient, to achieve the best outcome for the patient. The response to an eConsult could be:

A follow-up call to get more details or provide advice over the phone – this is the best option, especially for urgent communication
A message through the post-consultsultation (one way) messaging feature provided by eConsult – this is received as an email by the patient, but they cannot respond
A text or voicemail asking them to get back in touch or pick up their prescription from the local pharmacy
You letting them know you would like to see them – you may have already booked them an appointment

Practice policy must be adhered to and no clinical information left in the voicemail message or post-consultation email to ensure it conforms to Information Governance guidelines.

The post-consultation messaging feature provided by eConsult has a copy-paste functionality that allows you to add a note to the patient record regarding the contents of your message. Note that this feature is one-way, and is received by patients as an email that they cannot respond to.

Find out more about the post-consultation messaging service: Post Consult Messaging

Note that paediatric eConsults require a phone call as a minimum to close the encounter – this ensures that the clinician is satisfied with the history. The one-way post-consultation messaging facility cannot be used to close paediatric eConsults, and so is disabled. If your practice has an extended response time beyond ‘the end of the next working day’ then due to clinical risk paediatric eConsults are not available.

Many practices use eConsult to manage their on the day demand – this saves the duty doctor time taking patient histories and means more patients can be responded to or seen, if they need to be. Some practices are now so good at this, they can guarantee a response to eConsults submitted between a certain time window in as little as 2 hours. You can find out more about how these practices workflow eConsults on our case studies page

What do I do if I haven’t received my patient’s eConsult?

Each eConsult report has a unique reference number assigned to it by the eConsult system. You should ask patients to provide this reference number if they are enquiring about a specific eConsult they have submitted.

If there are any technical issues, you should contact your eConsult Operations Executive or practice.support@webgp.com and provide this unique reference number. You should not provide any patient identifiable details to eConsult or you may breach Data Protection and GDPR compliance.

What do I do if my patients are chasing me about their eConsult?

We find patients are most dissatisfied when they do not hear back from the practice within the stated time frame. It is therefore important to ensure that the practice has chosen the appropriate workflow to ensure delivery of these timescales, and that staff are trained and understand how to process eConsults.

eConsults are delivered to your designated practice inbox as a PDF form as standard – if there are issues, you should contact your eConsult Operations Executive or practice.support@webgp.com and provide them with the unique reference number assigned to the eConsult the patient is inquiring about. They will have been sent this unique reference number in the email confirming the submission of their eConsult – they may need to check their junk inbox if they have not received it.

Many practices use eConsult to manage their on the day demand – this saves the duty doctor time taking patient histories and means more patients can be responded to or seen, if they need to be. Some practices are now so good at this, they can guarantee a response to eConsults submitted between a certain time window in as little as 2 hours.

How safe are eConsults?

All of our templates are created by a range of clinicians and content is approved through our Clinical Governance process, designed in line with SCCI0129 requirements. The team meets regularly, led by our Medical Director and Clinical Lead for Urgent and Emergency Care. This allows for a multidisciplinary team approach that focuses on both clinical and patient safety.

Our Clinical Governance feedback is monitored 24/7. Any clinical incidents receive a full investigation by the Clinical team, the investigation is shared with the GP practice involved as we believe in an open, honest and transparent process. To report a clinical incident, please use this form.

Some templates allow patients (or guardians) to upload photos to assist the clinician in understanding the patient’s request for advice. We ask the user (the patient/parent/guardian) for consent at the point of uploading. All photo upload questions are optional and do not need to be completed by the user.

Under data protection law, your practice is the Data Controller, therefore any images received and uploaded into the clinical record will fall under the practice information governance and GDPR policies. eConsult doesn’t store or retain any of these images.

You can see who is on our Clinical Governance team here.

How do I report a clinical incident?

To report a clinical incident, please use this form.

This form is to be used to report any incidents or concerns from eConsult reports you have received. It enables our clinical development team to conduct an analysis of the event and recommend any changes to the system to reduce clinical risk, if appropriate. Clinical incidents should be reported as soon as the practice is aware of the incident having taken place – eConsult does not see personal details and so is unable to investigate incidents or concerns unless reported.

Please provide details of the event below and append an anonymised copy of the full eConsult report in question. Under Information Governance rules please do not disclose any patient identifiable information on this report or in any information you send to eConsult.

How does eConsult impact my indemnity/liability?

Using eConsult is covered under the Clinical Negligence Scheme for General Practice as an activity which is commissioned under a GMS, PMS or APMS contract (or related enhanced primary care elements under an NHS Standard Contract), and where a provider provides services directly or under a sub-contract. The location of the services being provided and whether they are digital or face-to-face will not affect the cover. The services/consultations must be being provided via a GMS/PMS/APMS contract and the consultations themselves must be connected to the diagnosis, care or treatment of a patient.

To ensure you are compliant, all practice staff must have completed the eConsult training. Certificates are provided as proof of training.

Historically, guidance has stated that paediatric online consultations will require either a follow-up telephone call or a face to face appointment.

As a company we stay in regular contact with NHS Resolution and provide them with relevant information.

For detailed information see our Medical Indemnity page: Medical indemnity

How do I know the patient is who they say they are?

Admin/reception staff should check that the patient is registered with the practice and also check that the patient’s details are correct when the eConsult is received.

When the patient is contacted by the admin team to inform them about the final outcome of the template, staff should ask some security questions to verify the patient’s identity such as:

“Please can you confirm when you last attended the practice and for what reason”
“Please confirm the name of your registered next of kin?”

If you are unsure of your local processes for patient verification, please contact the ‘Access Lead’ in your practice for further guidance.

What happens if I can’t respond by the next working day?

The standard eConsult response period of ‘by the end of the next working day’ has been carefully considered – taking into account patient uptake as well as clinical safety. If your clinical staff have reviewed an eConsult and feel that a response is not required by the “end of the next working day”, then that is your choice, and you absorb any risk.

Responding to the patient about their eConsult does not mean you need to resolve their query by the end of the next working day. Your response could be:

A follow-up call to get more details or provide advice over the phone – this is the best option, especially for urgent communication
A message through the one way post-consultation messaging feature provided by eConsult, a text or voicemail
You letting them know their prescription is now with the local pharmacy
You letting them know you would like to see them – you may have even already booked them an appointment

Note that paediatric eConsults require a phone call as a minimum to close the encounter – this ensures that the clinician is satisfied with the history. The one-way post-consultation messaging facility cannot be used to close paediatric eConsults, and so is disabled. If your practice has an extended response time beyond ‘the end of the next working day’ then due to clinical risk paediatric eConsults are not available.

Patient satisfaction rates are well above 80% for eConsult – we find patients are most dissatisfied when they do not hear back from the practice within the stated time frame.

Many practices use eConsult to manage their on the day demand – this saves the duty doctor time taking patient histories and means more patients can be responded to or seen, if they need to be. Some practices are now so good at this, they can guarantee a response to eConsults submitted between a certain time window in as little as 2 hours.

How do patients access the eConsult service?

eConsult can be accessed via your practice website on any device and at any time.

We strongly recommend you place a banner on your practice website advertising the service. Patients can then click on this to start their online consultation or look at self-help options and local services available.

We find that the dynamic banner, which pops up on the screen when patients visit your practice website and can then be minimised to the bottom of the screen, is the best way to drive patients to the service. You can also have a small banner or refer to the eConsult service on pages where patients could use eConsult to resolve their query – e.g. appointments page, online services information page or admin requests page.

Some practices have trained their admin staff to complete eConsults on behalf of patients over the phone, especially if the patient cannot access the internet or does not feel comfortable using online services.

What do patients see when they complete an eConsult?

You can submit a test eConsult using our demo site – some fields have already been filled out for convenience. You can also access the demo site to see the full list of available conditions templates.

Adult: http://demo.webgp.com
Paediatrics: http://demo.webgp.com/children

Why do patients have to enter their personal and demographic details each time?

We all have several logins and passwords that are hard to remember and a hassle to change – that’s why we decided not to have a login system. Patients will be able to use NHS login as it is rolled out across the country.

eConsult is rolling out on the NHS App at the moment.

What happens if patients submit eConsults when the surgery is closed?

All patients with urgent symptoms will be directed to seek urgent care by the system – they will not be able to submit an eConsult and you will not receive an eConsult for these patients.

Patients without urgent symptoms or wanting admin support will be able to submit an eConsult as normal – they will be told to expect a response by the end of the next working day. Their eConsult will be sent to your designated email inbox ready for processing when the surgery reopens.

It is generally a good idea to process any eConsults sent over the weekend or overnight in the morning, so that you can respond by the end of the day (and stick to the ‘response by the end of the next working day’). You may wish to hold some slots in the morning session for clinical staff to process clinical eConsults.

What can I do to get more patients using eConsult?

There are several things you can do to market eConsult to patients, which will drive uptake. Before you speak to your eConsult Operations Executive for advice, consider the following:

You may not be using the most efficient workflow – see how other practices use eConsult here
Is every interaction between practice (both clinical and admin staff) and patient used as an opportunity to advertise the service to patients?
Practices where the lead GP has recorded a personal voicemail or phone queue message asking patients to eConsult instead find their call volumes reduced
If your phone number is on the landing page your practice website or available on search engines, patients may call the practice out of convenience instead of using eConsult. You could remove the practice phone number and leave it only on the contact us page

Find out how else you could drive up patient uptake and usage on our resources page.

You might also find it useful to use some of our practice facing videos on your website, or within your practice website waiting room. Y ou can access our library of videos here.