Who uses WebGP, email, skype or telephone consultations in general practice?

Problem

In the UK there has been considerable rhetoric from policymakers about the potential for consultations conducted by telephone, email or internet video to alleviate staff workload and improve patient access. The aim was to explore feasibility of using routinely collected data to assess rates of use of alternatives to the face-to-face consultation in general practice.

Approach

We conducted case studies in eight general practices across England and Scotland, each practice having experience of implementing one or more type of alternative (telephone, email, WebGP, Skype). We extracted anonymised details of registered patients and consultations with all health professionals over one year. We used these data to assess annual consultation rates and explored relationships between patient characteristics and use of alternative forms of consultation by practice. We assessed the proportion of consultations which are followed by a re-consultation within 14 days.

Findings

It was technically feasible to extract the required data. However practices used a variety of methods to record type of consultation and substantial effort in data cleaning, merging and recoding was necessary before analysis. 91% of telephone consultations and 94% of WebGP consultations were recorded correctly in records but only 63% of email consultations. None of the practices provided any Skype consultations.The dataset included 342,633 valid consultations of which 80% occurred face-to-face in surgery. Use of alternatives was extremely low even in case study practices that had actively promoted their use. Telephone consultations accounted for between 8% and 30% of consultations in different practices, email for 0.2% to 0.5% and WebGP for 0.16% to 0.17%.Face-to-face consultations were more common in older patients, women, those from non-white ethic groups and those with multimorbidity. There was little association with deprivation. Telephone consultations showed similar patterns but with higher rates in more deprived areas. For electronic consultations (WebGP/email consultations combined), these relationships were reversed. Rates were lowest in deprived areas, patients from minority ethnic groups, children and the elderly.Rates of re-consultation within 14 days varied according to the type of consultation and professional but were higher when the index consultations was not a face-to-face consultation conducted by a GP.

Consequences

It is feasible to extract routine general practice data, but analysis of consultation rates is complicated by idiosyncrasies in recording behaviour. Face-to-face consultations account for the vast majority of all consultations. Use of alternatives other than telephone calls is extremely low.Patients using electronic consultations have markedly different characteristics from those having face-to-face or telephone consultations.The tool used to export patient characteristics and create a multimorbidity score for use in EMIS general practices is available to other users via our website resource.