So what is an e-consultation?

Well I was right about the bombardment of doom ceasing for just one day.  They are at it again, and  NHS England’s £2.4 bn GP Forward View is “not nearly enough, not the right stuff and not soon enough.”  Never mind, it is what it is.

Though not one of the 1700 words Shakespeare coined,  “e-consultation” is centre stage and the thing that is going to transform general practice for a mere £45m.  However, with no definition of what it means, I’d like to propose one, starting from the basics.

In our context, a consultation is a personal interaction between patient and clinician in order to provide medical help.

Where traditionally they have all been face to face, remote consultations can take place by telephone, video or digitally.  (Letter would also fit the definition but I’ll assume there is little call for this.  Even faxes are being smashed in the new modernisated NHS).

E-consultations are therefore a subtype of remote, and to hone the idea let’s look at what falls outside:

  • not simply booking an appointment online (no interaction)
  • not NHS 111 (even if it is digitised, only an algorithm, not patient-clinician)
  • not Skype or other video, as like telephone these are synchronous means, patient and clinician present at the same time.
  • not symptom checkers (not personal)

Therefore I propose:

An e-consultation is a personal interaction between patient and clinician initiated by digital means.

All very dry, and I think Shakespeare would have put it in plainer English along the lines of:

The patient seeks help from their GP online.

It’s much more fun to have a go.  To my knowledge there are two systems available to NHS GP patients, our own askmyGP and Arvind Madan’s with Hurley Innovations Ltd.

You can try both as a dummy patient:

askmyGP demo

webGP/eConsult demo

Next week I’ll compare the two feature by feature from published evidence.

Meanwhile, I’m interested in your views on the definitions and demos – please comment below

Harry Longman

 

PS: If you missed the webinar in our series on Demand Led GP, you can see the recording here of “Unblocking the appointment system”  getting to grips with demand and capacity.  I explain how you can do your own Loadmaster for £35, which is proving popular.

3 responses to “So what is an e-consultation?”

  1. Harry Longman says:

    Malcolm Thomas writes: No need to redefine “Consultation”. Put brilliantly in 1960 by (Sir) James Spence

    “The essential unit of medical practice is the occasion when, in the intimacy of the consulting room or sick room, a person who is ill, or believes himself to be ill, seeks the advice of a doctor whom he trusts. This is a consultation and all else in the practice of medicine derives from it.”

    So you just have to work out how to define the “e” bit

  2. Harry Longman says:

    Alan Dow writes:
    We, and I’m sure many practices, use a message book ie patient asks a question which is entered in their record with a non urgent reply expected within 48h (as we say for scripts though they are all answered same day in practice). It would be enhanced with records access for things the patient could check themselves and then needn’t ask – and to see the reply without calling via reception. I am continually surprised how well it works and is liked as I would imagine it tying up receptionist time and being frustrating to have multiple “gos” as asking an answerable message sometimes- but it seems very popular

    • Harry Longman says:

      Agree, I hope practices do use something like this for short messages. However, if it’s really “I have a problem, I need help…” an unstructured email or message thread soon becomes impossible to manage. While there is sure to be a grey area between these, I think the potential for dealing with everyday demand lies with good structure and history taking.

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