The lightbulb moment for me came when I processed an eConsult for a patient who was visiting their family in Newcastle. The patient consulted online and needed a follow up phone consultation followed by a prescription, which I sent electronically to a local pharmacy near their family. I realised in a virtual space, geography is irrelevant, patients and doctors can be miles apart with absolutely no impact on the care provided. I questioned why a patient’s individual surgery needed to process all online consultations, couldn’t they be processed centrally as long as the GP has access to the patient record? The eHub was born, January 2017.
I’m a self-confessed techy GP who has fully embraced online consulting since the launch of eConsult in 2011, I love the fact that digital is disrupting every aspect of our everyday lives, from banking and shopping online to Uber and Airbnb, technology has created a new normal. Once I started working with online consultations, the faster I was able to process them and the more I was able to close remotely without the need for a face to face appointment. This is not the case for everyone, some need time to familiarise themselves with the technology, and some are resistant to such a new innovative way of consulting which can lead to a lack of enthusiasm, little promotion of the service by the practice and therefore low take up by patients. The eHub was designed for the Hurley Group to take online consulting out of the 15 individual practices and to move to a central processing model. Any patients requiring a face to face consultation would be passed back to their own practice.
The eHub started small with one clinician, two mornings a week, even then I worried that there wouldn’t be enough work to keep us busy. We offered to help the practices tackle their long list of blood and lab results and electronic prescriptions – they willingly passed this work over and we continue to take this overflow today. As demand for online consultations grew, so did the eHub. Today, 90% of all online consultations in the Hurley Group are dealt with centrally by the eHub and we hope by the end of this phase of development, this will reach 100%. In phase one we proved it could work, phase two we built capacity to deal with volume and in phase three we are centralising all online consultations with everything being done methodically and safely, with individual practices working in parallel with the eHub.
As the number of patients using eConsult has grown, so has the volume of applications from GPs wanting to work in the eHub, attracted by flexible working either at the eHub based in South London or from home. Recruiting enthusiastic virtualists isn’t our only priority, we insist all eHub clinicians are practising GPs who maintain face to face contact with patients. Dealing with online consultations is a completely new skill that has to be learnt from scratch, you can’t simply crowbar primary care medicine into online consulting. We have developed a competency framework based on RCGP competencies, a governance and clinical quality framework and a training and supervision programme. Those who learn the skill, reap the benefit. Specific training is the key component in making virtual general practice work. I have personally trained many doctors in online consulting and, without exception, in the first clinical case they process they recommend a face to face consultation, ‘just in case’. When a GP joins the eHub, their remote closure rate is around 60%, rising to 86% post training. On average one eConsult can be processed remotely in three minutes, saving six to seven minutes from the normal 10 minute face to face slot.
We find GPs love working for the eHub and the flexible ‘mix and match’ approach combining face to face and virtual consultations provides great variety. Doctors who have been out of practice, perhaps for maternity leave or other reasons, find stepping back into the work place via the eHub a real confidence boost as they get great support from working closely with others.
It’s not only GPs who are enjoying interacting with eConsult. Patient satisfaction surveys report that 81% of patients would recommend the service to friends and family, and 74% of patients would eConsult again rather than book a face to face appointment.