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As general practice reaches saturation point, with a recent 16% increase in the number of consultations with GPs, the search is on for new ways of working which will free up GP time and provide high-quality care to increasing numbers of patients.

NHS England plans to offer support to all practices in adopting online consultation systems, and £45 million has already been committed. Is this likely to provide value for money?

MSc student Michael Casey (Queen Mary, University of London), Dr Sara Shaw (University of Oxford) and Dr Deborah Swinglehurst (Queen Mary, University of London) have evaluated one model of online consultation, the Tele-Doc System, in which communication with the patient is by email exchange only, without real time audio or visual contact with the GP, and report a number of concerns.

Despite the extra effort and administrative time put in by the practices, uptake by patients was low and there was little evidence that efficiency gains were realised. Although the system could work well for simple problems, it was often ill suited to consulting about complex problems, and overall workload may have increased. There were also concerns that, no matter what the complexity of the problem, taking the face-to-face contact and emotional content out of the consultation could be a serious problem. The authors comment that "the emotional work of consulting may be marginalised, and there may be important limits about what is achievable in this new genre of consulting".

Read more

Experiences with online consultation systems in primary care: a case study of one early adopter site.
Michael Casey, Sara Shaw, Deborah Swinglehurst. Br J Gen Pract 9 Oct 2017.  bjgp17X693137. DOI: 

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