by Dr Murray Ellender

Our response to the CLAHRC study

Current evaluation on the impact and efficacy of phone, video and online consulting is restricted to a study undertaken between April 2015 and June 2016, the results of which were published in late 2017. The study was undertaken across 36 pilot GP practices in South West England in the early stages of mobilising online consultations using the eConsult platform.

This research was funded by the One Care Consortium Ltd and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West at University Hospitals Bristol NHS Foundation Trust. The One Care Consortium facilitated data collection.

The study was made available to eConsult a year before publication, and its recommendations immediately adopted. As a result, we saw a doubling in the use of econsultations across the country from 2016 to 2017, and a fourfold increase across a single London CCG in 2017.

This has also made eConsult fully compliant with the recommendations made by CLAHRC West to commissioners, which are:

  • Does the system integrate with current IT systems used in the practice?
  • Does the system encourage self-care and signpost patients to the most appropriate service eg, a pharmacy for hay fever or common colds?
  • Does the system operate a red flag approach, so if patients’ symptoms seem urgent, they are directed to a service that will promptly review their query?
  • Does the system ask patients enough questions so practitioners have sufficient information to make clinical decisions?
  • Is the system easy to use for patients and does it use straightforward language?
  • Do patients have opportunities to:
    • nominate a preferred GP to look at the query
    • upload a photo
    • request administrative clinical support such as test results, medical certificates or repeat prescriptions, without needing to answer a complete medical questionnaire?

Academic studies are important but whether they are the most effective way to evaluate rapidly evolving technologies is questionable. A time lapse of 18 months between study completion and study publication does not reflect the status quo where all online consultation models have evolved significantly since their early pilot days. Until new academic data is available, we continue to collect and analyse data on a weekly basis, listen to clinical and patient feedback and constantly refine the eConsult platform for ease of use, efficacy and, most important of all, clinical safety.