August 10, 2017
Adding to the evidence base: One Care research collaboration
As part of the GP Access Fund programme, One Care had the opportunity to test a number of innovations that were said to improve access to appointments while reducing the demand on general practice. There was keen interest in using online consultation software across the primary care sector, so we worked directly with practices to identify their priorities around this. This led to a pilot involving 36 practices across BNSSG. The aim was to assess the impact, effectiveness, acceptability and costs of web-based access to primary care. The product chosen was called eConsult (previously, webGP).
Given the significance of technological innovation, and the fact some evidence suggests that non-traditional modes of contact have yet to offer significant benefit, One Care asked external researchers to evaluate the pilot. The evaluation analysed data from nearly 36,000 eConsultations, patient feedback, and undertook in-depth interviews with 23 practice staff involved in the pilot.
The study has been published by the Society for Academic Primary Care (SAPC) and was presented to the SAPC annual scientific meeting in Warwick this month. It was funded by One Care Consortium and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust. Pulse have also published an article about the research.
It was found that use of eConsult was low and the system was mostly used during traditional surgery opening hours. The most common reason for an e-consultation was for administrative reasons (e.g. requesting fit notes, repeat prescriptions). 38% of e-consultations resulted in a face-to-face consultation, and a further 32% were telephoned by a clinician, suggesting that the impact on reducing demand was limited during the pilot perido. Better marketing of the system may help, but practices were understandably wary of promoting a system to their patients when the impact and its continued availability was uncertain.
Patients gave feedback that they valued the system. Clinicians said eConsult works best for simple, routine enquiries. When complex or new symptoms were presented, clinicians wanted to see the patient. The lack of integration of the platform with existing systems also created complications in work flow within practices.
Therefore, while the results indicated that there is an appetite to engage with digital communication, the study did highlight difficulties. The challenge for the future is to test the system once technical developments are available.
With thanks to the One Care project team, researchers from the local Collaboration for Leadership in Applied Health Research & Care, funded by NIHR. https://clahrc-west.nihr.ac.uk/, and especially to the patients and practices who generously took part in this study.