Digital triage tool eConsult has helped some GP practices to reverse their usual ratio of face-to-face/remote patient consultations since the COVID-19 pandemic hit the UK, with one multi-site practice estimating that 90% of its digital consultations are now completed remotely. Previously, up to 45% would usually lead to a face-to-face appointment.

Dr Mark Harmon, an urgent care consultant and eConsult strategic director, described the tool as the ‘digital front door’ to a general practice. It is currently used by more than 2,500 NHS practices – approximately one third of the UK total.

The patient enters eConsult via the NHS app or their practice website and starts by completing a questionnaire. This is then reviewed by the practice before the patient is triaged to the most appropriate resource, from self-referral services, self-help information, and pharmacy advice to a phone, video or face-to-face consultation with a GP or a specialist nurse, or the hospital accident and emergency department.

“The system consolidates all the answers and reports to the GP within seconds, so they can decide what to do with the patient – depending on any flags that it raises,” said Dr Harmon. “If the GP does need to see the patient ultimately, eConsult provides them with a rich history of the digital consultation.”

COVID-specific screening questions were added to the application within two hours, as soon as the potential impact of the pandemic on GP practices was understood.

Dr Harmon said that in terms of the adoption of digital technology – and the behavioural changes that are needed to make it effective – GPs have advanced by the equivalent of four years in the few weeks since the virus arrived.

WHAT'S THE IMPACT

“eConsult is a true multi-disciplinary tool that allows practices to share resources and use them much more efficiently,” said Dr Harmon. “It also means that GPs can work from home if they are self-isolating.

“None of us would have wished for this crisis but as a software company, we were able to act really quickly. Digital triage is a complete game-changer for the way that practices are run. A lot of young GPs are very tech savvy but it’s still difficult to install new technology in a traditional surgery – there is never enough time, and change management is a challenge.

The virus rendered the convention of a face-to-face GP consultation model out of date almost overnight, Dr Harmon suggested. “Before the crisis, GPs were seeing 90% of their patients face-to-face,” he said. “Now, 90% of practices are using remote consultations. It is a complete reversal. The crisis has accelerated adoption and I believe we will never go back to the way we were.”

He said that non-digital patients would continue to be catered for with dedicated phone lines.

WHAT'S THE TREND 

Dr Ian Pawson, a GP partner at Brownlow Health practice in Liverpool, said that being up and running with eConsult and already having set up a full infrastructure around the delivery of a triage model helped the practice to be flexible in the face of the pandemic.

“Due to the pressure to avoid any face-to-face contact that isn’t absolutely necessary, we have gone from turning about 40-45% of our eConsults into face-to-face appointments, to managing over 90% remotely this week,” he said.

“We are all feeling the impact of COVID and the response this has generated already within NHS and particularly primary care is likely to change the landscape of general practice entirely in the future. It feels like we have made years’ worth of progress in a matter of days, and I am hopeful we can continue to build on this to consolidate and develop even more intuitive systems, and a way of working that can benefit both patient and doctor.”

ON THE RECORD
Joe Nicholson, improved access project manager at Beacon Medical Group in Devon, said that the greater among of clinical information being captured by eConsult has helped isolating members of the practice’s GP and urgent care teams to work remotely and safely decrease the number of in-surgery appointments:

“We have decreased our appointment rate for GPs from 35% to 7%,” he said. “This has reduced the demand on clinical team members, who are able to see patients face to face but also provides information, prior to patient’s arrival, about key risk factors associated with COVID-19.

“We have also been able to reduce the number of COVID-related queries reaching our GPs. Patients can text questions using the administration functionality and in most cases, we have been able to direct them to government advice or other services."