New analysis by the Improvement Analytics Unit (IAU) – a partnership between the Health Foundation and NHS England and NHS Improvement – finds that only 10% of patient care requests made to GP practices indicate a preference for a face-to-face consultation.
The analysis examined data from 146 GP practices in England using the askmyGP online consultation system between 1 March 2019 and 30 September 2021, including over 7.5 million patient-initiated requests for care. Use of the online system allowed analysts to follow patients’ journeys from the initial point of contact through to delivery of their care. This information was examined alongside data captured on patient characteristics, clinical needs and preferences.
It found only a minority of patient requests for care stated a preference for a face-to-face consultation – falling from 30% of requests before the pandemic to less than 4% at the start of the pandemic. And while requests for face-to-face consultations did increase after that, they only accounted for 10% of requests by the end of the study period in September 2021.
Telephone consultation was the most popular patient preference, favoured on average in 44% of requests pre-pandemic, and by 55% of patients in both 2020 and 2021. Requests for a response via SMS/online messaging accounted for on average 26% requests pre-pandemic, rising to over a third in 2020 and 2021. Fewer than 1% of patient requests asked for a video consultation.
The study’s authors note that, while more work is needed to examine the risk that online consultation systems will create inequalities in access, non-digital users did not appear to be disadvantaged by the move to greater adoption. Traditional routes of accessing and delivering care were offered alongside the digital system, and practices were able to tailor care according to a patients’ characteristics, clinical needs and preferences. For example, patients older than 74 years were up to 28% more likely to have a face-to-face consultation than those aged 25-44 years. Those asking about new medical problems (around 40% of requests over the study period, although they dipped to around 30% at the start of the pandemic) were two-thirds (67%) more likely to be seen face-to-face than those asking about existing medical problems.
The analysis also found that, at practices adopting a ‘digital-first’ approach, most patients initiated care requests via the online consultation system, rather than by telephone or in-person. Even before the pandemic, the largest proportion of patient requests were initiated online – this increased from 60% in June 2019 up to 70% just before the pandemic in March 2020, while overall demand remained low and fairly static over this period. During 2021, 72% of all patient requests were initiated online rather than by telephone or in person. And once patients had accessed their GP online, they were 25% more likely to do so next time compared to those who had not.
Arne Wolters, Head of the Improvement Analytics Unit at the Health Foundation, said:
‘Since the start of the pandemic the use of online consultation systems such as askmyGP has accelerated. But a common concern around use of digital tools is their potential to create inequalities by making it difficult for some patients to access care. While this is certainly a risk, our analysis shows that patients often choose remote over face-to-face consultations and that GP practices can mitigate the risk of digital exclusion via a blended approach. Traditional routes to accessing and delivering care were offered alongside an online option and, in planning care, practices were able to take account of factors such as patients’ age, frequency of use, clinical needs and preferences.
‘Our analysis provides further evidence that online consultation systems can facilitate choice and flexibility in how primary care is accessed and delivered. With patient demand at an all-time high due to the care backlog that has built up during the pandemic, digital tools can help practices manage this pressure, enabling them to triage patients to the right person or service and prioritise face to face consultations for those that need them most.’
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