Written evidence submitted by eConsult (FGP0120)




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Submission response:

What are the main barriers to accessing general practice and how can these be tackled? What are the impacts when patients are unable to access general practice using their preferred method?

What we are facing in General Practice is not simply a problem regarding patient access to care, but having access to the right care. During the pandemic, most practices have trialled digital care, and the rise in demand and implementation of digital triage since the start of the pandemic has contributed to the rising number of online consultations and access to GP appointments.

The number of Primary Care GP contacts is now significantly higher than pre-pandemic levels in part thanks to digital triage. In the NHS Digital report on month on month GP attendance stats 30.4m consultations were delivered in general practice in September, 40.3% of these on same day requested. This is nearly 2m more than in September and nearly 7m more than in August.

However, due to national underinvestment in digital tools and services and understaffing, this has not been successful in every practice. According to eConsult’s latest research, 20% of patients are still self-referring to A&E because they have run out of patience when trying to book a GP appointment. Our latest data also tells us that nearly half of UK adults who visited the emergency room in the last 12 months did not require urgent A&E treatment. In fact, upon seeing a medical professional, 24% were told to visit another health professional, 13% of whom were sent to their GP, and 11% were sent to a pharmacist.

Too many practices still rely on inefficient telephone triage, which requires a clinician to call every patient back to triage them. By contrast, in digital triage every patient contact comes with structured information up-front, substantially increasing the efficiency of decision making.

The current mixed system of insufficient and disconnected triage is putting pressure not only on GPs, but clinicians in A&E and secondary care. Harnessing technology and digital innovation is critical to opening up the doors to primary care and freeing up resources so the clinician can focus on fast-tracking those patients to the right point of care for their symptoms. This will also help reduce bureaucracy, better utilise resources across teams, reduce burnout and improve morale among GPs.

Transitioning into person-centred models of care will undoubtedly require new skills and leadership capabilities. To best determine what skills and competencies are needed, work needs to be done to examine the evolving role of GPs and other healthcare professionals (HCPs). Updating training standards and criteria would mean that the necessary skills are in place to support digital enabled transformation and changes in practice, both at the local and national level. This would result in HCPs leveraging, utilising, and integrating digitally based health solutions and information tools as required.

The present siloed health systems are not adapted to the necessary level of reconfiguration of servicesa collaborative approach to Integrated Care System working is required. Moving from a simple aggregation of silos to a more integrated population health system is dependent on an effective and well-thought digitisation and interoperability strategy, which is important for improving patient outcomes and driving system efficiency.

What are the main challenges facing general practice in the next 5 years?

The government must invest in the system change necessary to reform digital services and the NHS’s digital infrastructure. This will help confront one of the main challenges which is widespread inefficiency in the NHS that leads to many people scrambling at 8am for an appointment, sometimes waiting days and weeks to see a clinician, and sometimes receiving care from a GP or A&E that could have been met by a pharmacist, or other more appropriate HCP. Online access to GPs has removed many of these barriers, but there needs to be more investment if we are to move to a needs-based system.

Asynchronous consultation saves clinical time and improves the level of information available to the clinician by asking the patient to provide a comprehensive history. In addition, the use of pre-assessments and shared decision-making tools offers the opportunity for GPs to deliver a better-quality appointment. Having useful information up-front about a patient’s status and their preference can lead to a higher quality of care and richer dialogue, ensuring patients are seen on the basis of clinical need.

Although there will always be a place for face-to-face appointments, it is unsustainable with current staffing levels for doctors to see every patient. Nor does every patient require a face-to-face appointment. Digital triage tools like eConsult enables GPs to offer online consultations via their practice website, and allow patients to submit their symptoms or requests to their own GP electronically. This is improving the level and speed of care for patients. - As one patient at the Drayton Surgery in Portsmouth informed us, with the aid of a digital consultation tool, a doctor had assessed my symptoms and identified the need for action the same day. Very efficient and saved a visit either to A&E or a walk-in centre.” Going forward, one of the major challenges will be to find the crucial blend between face-to-face appointments alongside remote appointments nationwide.

To what extent does the Government and NHS England’s plan for improving access for patients and supporting general practice address these barriers?

NHS England’s plan for improving access to patients is a welcome start. For instance, the new programme, which will help support more than 200 practices with access problems and provide them with tailored improvement plans that include making use of appropriate digital tools. However, while there was some reference to remote consultations and triage, there needs to be more specific guidance and support for practices adopting these tools. Implementing digital triage can be time-consuming for practices that are unfamiliar with system change and there needs to be protected time for staff to ensure that appropriate training is delivered.

Although the focus on general practice is important, as this is the gateway to NHS services, it is also crucial that we view this plan within the context of secondary and urgent care. The NHS is facing pressure across the whole service, and this requiring a holistic approach that capitalises on innovations in the sector.

Using digital capabilities to redesign care, such as delivering integrated care and using population health data to drive predictive interventions, offers the opportunity to improve health outcomes over the short, medium, and longer term. Ultimately, the aim should be to ensure people can access appropriate health and care services consistently as and when they need to, in a way that meets their needs.

What can be done to reduce bureaucracy and burnout, and improve morale, in general practice?

Through implementing digital and online triage in NHS primary care, teams would be able to use their working day more efficiently, resulting in a more streamlined, efficient working model, which in turn improves work satisfaction and morale. By knowing a patient’s symptoms upfront, GP practices can manage patients by clinical need  and are then able to care for that patient based on the appropriate resources available. This results in increased practice efficiency. By reducing inappropriate GP appointments that do not require a face-to-face appointment, it reduces pressure on NHS GP staff and saves time and prevents resultant stress. The eConsult platform empowers GPs, HCPs and practice staff to use their working day more efficiently, resulting in an improved work-life balance and staff retention.


Dec 2021