On-line GP consultations dangerous & ineffective


BUCKETS of cold water have been poured on Tory plans for patients to see their GP over the internet rather than face-to-face.

The pilot study has shown that just two out of 1,000 patients used the on-line service and a big proportion of those still had to come in for a face-to-face consultation. Meanwhile, doctors have warned that on-line consultations are dangerous as symptoms can be missed, especially in the case of cancer, where if patients are not diagnosed early they have more chance of dying.

At the BMA London region conference, motions opposing the scheme were voted on and passed.

The study, which was carried out by academics at the University of Bristol, found that where the ‘on-line consultations’ were piloted in 36 practices, the use and effectiveness was ‘limited’. The 15-month pilots took place in Bristol, North Somerset and South Gloucestershire.

The plan was to roll out the system dubbed ‘eConsult’ across the country as a ‘cost cutting measure’ to reduce the amount of people that come into GP surgeries. The report concludes that ‘on-line consultations’ are not key in reducing doctors’ workload or cutting patient waiting time.

Furthermore, they do nothing to resolve the source of the crisis which is the lack of GPs and staff, the mass closure of GP surgeries across the country and the dire lack of funding for GP services.

The National Institute for Health Research-funded study evaluated eConsult. It discovered 38% of the on-line consultations led to a face-to-face contact and a further 32% led to a phone consultation.

Dr Jeremy Horwood, from the University of Bristol’s Centre for Academic Primary Care, said: ‘On-line consultations may have value for some patients, such as straightforward medical enquiries, but they cannot replace face-to-face consultations in situations which are more complex.’

Deputy chair of the London region BMA, Anna Athow, said: ‘General practice is massively underfunded and there is a shortage of 5,000 GPs. The NHS England agenda is to pressurise GPs into using online methods of communication with patients, supposedly to save time, and as a way of managing with too few GPs. On-line consultations could lead to serious conditions being missed and put the patient’s life at risk.’

At the recent GP conference of Local Medical Committees on the 10th November, GPs voted against this pressure from NHS England, arguing that there is no evidence that GPs’ workload is any less, and that many patients would be disadvantaged.

The motion, also cautioned that on-line consulting was likely to decrease access of more vulnerable patients who may struggle to use the internet and would add to, not ease, ‘an already unmanageable GP workload’.

Meanwhile, the Tory Chancellor announced that NHS Hospital trusts will be handed £335m to ‘deal with urgent winter pressures’. When you consider the NHS budget for the year is £123.8bn, the metaphor of attempting to bail out a sinking ship with a teaspoon comes to mind. Trusts will also receive £100m to place GPs in A&E ‘streaming services’ in every hospital this winter. This is an extremely dangerous development where GPs are placed at the front door of hospitals and told to divert patients back out the door of A&Es and sent home if it is deemed that they do not need to be there.

RCGP chair Professor Helen Stokes-Lampard said: ‘The Chancellor has recognised the need for additional funding for the NHS to cope this winter – but it’s very disappointing that he has overlooked the increased pressures that GPs and our teams will be under, and the role general practice plays in alleviating pressures on our colleagues in secondary care.

‘As we told him in our letter ahead of the budget, the entire health service is struggling to cope with ever-increasing levels of demand – and as winter approaches, this will only be intensified.’