eConsult is changing from 8th Nov 2021

Dear Patients,

Over the past few months, you will have noticed that eConsult availability has been dependent on our daily capacity to manage these safely. From 8th Nov 2021, there will be further changes. Thank you for taking the time to read on as it may help to explain our current position, which is not unique to us but also impacts most GP surgeries.

As a result of the pressure to provide ever more face to face appointments, coupled with a new specification in the national Primary Care Network (PCN) contract from Oct 2021 stipulating the number of online consultations to be offered (5:1000 per week), there will be a further streamlining of eConsults that are offered daily.

From Mon 8th Nov 2021, eConsults will only be offered for:

Suspected urinary tract infections in adults
Med 3 requests (sick notes for absences longer than 7 calendar days)
Dermatology skin rashes or lesions (only if a photo is attached)
Medication review for less than 5 medications on repeats
Musculoskeletal (MSK) conditions that are not new or acute e.g. osteoarthritis, gout – all new 1st presentations of MSK conditions will be directed to our specialist First Contact Physiotherapist
Medical reports requests

For all other conditions outside of this scope, please telephone the surgery directly where you will be offered a telephone or face-to-face appointment where appropriate.

Read our general eConsult guide to get the most of out this service.

Like all other GP practices, we have seen an unsustainable rise in demand for all of our services. This rising demand has not been matched by an increase in workforce. Latest data shows that there are now fewer GPs in England, despite repeated Government pledges to increase GP numbers (12) . We are always seeking to recruit more GPs but with a dwindling workforce pool, recruitment remains extremely challenging for the foreseeable future.

As a result of this rise in demand, we are squeezing more and more into our daily contracted hours, which increasingly stretches to 12-to-14 hour days. A “part-time” GP often works the equivalent of full time hours once you account for all the bureaucracy, admin and paperwork that comes with patient care. This is unsustainable, unsafe, and does not allow us to provide the quality healthcare that you all deserve. It increases the risks of medical errors for you, and burnout for us. It also makes General Practice an extremely unattractive job, thus making recruitment even more difficult.

Online consultations have been part of NHSE’s wider Digital First plan for Primary Care, and is likely to stay with us. There was an accelerated implementation during the pandemic in 2020 due to social distancing restrictions. In our case, when we started using eConsult in 2020, we did not have a choice regarding which platform provider we could use – the contracts were awarded by the Clinical Commissioning Group (CCG), independent of any input from GP practices. We do not own, or have shares in eConsult, and we have no control over the content or length of the forms.

We realise that online consultations are convenient for some patients, but not for all. We are mindful of the need to mitigate health inequalities for those patients who cannot or are unable to use online platforms. This means that in an already stretched working day, we have to find a balance of online vs telephone vs face to face consultations. This is on top of managing several hundred daily prescription queries, investigation results, and hospital letters and correspondence with our hospital and community specialist teams. We have also discovered that Clinicians frequently end up needing to telephone or arrange face to face appointments for eConsult patients due to inadequate information within the eConsult to enable safe disposition – this creates a huge inefficient drain on already scarce appointments.

Put simply, we have the same (if not fewer) numbers of Clinicians to deal with more consultations, tasks, referrals, investigations directly related to patient care. Imagine a traditional restaurant being asked to take on online orders via services such as Deliveroo or Uber Eats, on top of offering their usual table service, but without the ability to take on additional kitchen staff. That same number of staff must now deal with higher numbers of orders, which leads to either inevitable delays or compromised quality of food and service.

Healthcare should not be a conveyor belt service. General Practice has always thrived on forming lasting relationships with its patients, and GP surgeries have always tried to make decisions with the emphasis on individualised patient care. However, unmitigated pressure and demand from all quarters make it increasingly difficult to provide that same individualised care. The backlog with hospital care has also increased GP workload, as patients with complex needs that should be under specialist care and review are waiting longer for their hospital appointments. We are dealing with significantly higher number of patients as a result of the pandemic e.g. mental health and long Covid conditions.

In the current system where capacity and resources are finite, we have had to make the difficult decision of introducing these changes.

We will of course keep you updated as circumstances evolve.

Thank you for your patience and understanding.

  1. Nuffield Trust – What does the GP Workforce look like now?
  2. BMA – Pressures in General Practice