Online consultations - Frequently Asked Questions
Is there a generic process for all practices for managing online consultations?
- A practice checklist has been put together for practices to follow when managing online consultations.
- Receptionists can use the receptionists CRIB sheet provided by eConsult as a guide on how to redirect patients appropriately
Are there a lot of follow up appointments after an online consultation?
- Generally, the experience is that patients do not need to re-consult for the same thing. For practices nationally and in NW London, 60%-70% of online consultations were closed off remotely without a follow-up face-to-face appointment.
Clinical Accountability and Indemnity
What happens if the online consultation is considered urgent?
- If a patient responds with symptoms that suggest it is unsafe for them to complete the online consultation. The eConsult red flag system notifies them to seek a more appropriate case setting. Patients are informed that their GP will not be notified.
What is the medical and legal cover for online consultations?
- As confirmed by the MDU and MPS, online consultation is now seen as normal patient interaction and GPs do not need to notify their insurance bodies. This is because the service is offered to their registered patients and they have access to the patient’s notes.
What is the process in place if the system goes down?
- On the rare occasions the system goes down, including when a patient is entering a query, the form does not get submitted and the query ends. At this point the patient will need to contact their practice via alternative route such as phone call.
- If the issue persists for more than 15 minutes, eConsult sends an email to all practices impacted by the issue.
- The eConsult form will remain inaccessible to patients until the issue is resolved.
What is the medical indemnity plan around online consultations?
- eConsult have confirmation that the Clinical Negligence Scheme for General Practice (CNSGP) covers all practice staff who supply primary care services under a GMS/PMS/APMS contract. This includes the processing of online consultations both during core hours and out-of-hours. eConsult has also advised users to follow GMC guidance on remote consultations and prescribing as best practice.
Is there indemnity cover for clinical triage of eConsult emails sent after 6:30pm and before 8am?
- Indemnity during ‘out of hours’, staff are covered by the CNSGP for out of hours work. There is no additional indemnity required.
Communications to patients
What tips are there on the best ways to communicate with patients and engage them in the service continuously?
- Tailored text messages to patients
- Voice messages diverting patients to the website to complete an online consultation form
- Voice messages diverting patients to the NHS App to complete an online consultation form
Is there a message to patients after they complete the form?
- Patients will receive an email from the system to confirm the online consultation has been submitted to the practice, and they are also informed about the next steps and what to do if their condition worsens.
What is the response time for a patient submitting an online consultation?
- By the end of the next working day. When a patient submits an online consultation, they will receive a response from the system that notifies them to expect a response by 6:30pm the next working day, where the day will also be specified. E.g. If it is submitted any time up to 23:59 on a Friday, the system will let the patient know a response will be by 6:30 pm on Monday. If it is a bank holiday it will say by 6:30pm on Tuesday.
Can practices add links for the eConsult system to practice kiosks?
- The access to eConsult is a URL. If you can imbed URLs in the kiosk then you can add the link to eConsult on your practice website.
How do you avoid confusing patients and staff when there are multiple entry points to online consultation e.g. through practice website, SystmOne Online, patient access etc.
- To complete online triage form patients should be encouraged to use the following entry points:
- NHS App
- Practice website page
- Receptionists can use the receptionists CRIB sheet provided by eConsult as a guide on how to redirect patients appropriately
Processing eConsults – support and guidance
Is it possible to custom set the time within which the patient should expect a reply back?
- Yes - you can set the time that they will receive a response back within one working day. But you cannot change the fact that a response is required within one working day.
What is the follow up process for patients exiting the eConsult process prematurely?
- Initially eConsult did send truncated eConsult reports to GP practices every time a patient was diverted from a red flag question and the process terminated. Feedback received from clinicians was to remove this notification as it imparted accountability back on GPs to chase up the outcome of every patient - for example, did the patient call 111 or attend A&E as advised, do I have to check? These concerns are exacerbated when interactions occur during the out of hours period and weekends.
- eConsult’s position has not changed over the years and the vast majority of users agree that the system signposts the patient to take action and the responsibility is on the patient using the service to heed this advice.
- eConsult does not store any personal identifiable information once the consultation has ended and do not notify the practice. The only information eConsult store is on the number of diversions that have occurred.
What advice is there for managing the pdf/email format in the initial stages?
- The ‘how to manage eConsults’ guides provided by eConsult detail how to import the eConsult pdf unto EMIS or SystmOne.
- EMIS and SystmOne are unable to save pdf files, so when saving the eConsult, it gets converted to a photo document. This means the link within the document is inaccessible once saved. Practices are advised to create a local folder to save all pdfs so they can be accessed at a later point for post consultation messaging.
- Please note this is only a temporary resolution until integration is switched on.
When a patient sends in a query, eConsult’s automated response to the patient is that a member of practice will contact them by the "end of the next working day". Can this time be increased to at least response within two to three working days?
- The lengthening of response times is something that eConsult have offered in the past, but no longer do so. There are several factors around this:
- The eConsult is a snapshot of the patients presenting complaint and cannot identify escalating symptoms. Therefore, a longer response window can create a less accurate clinical picture for clinical review.
- eConsult understand the desire to make this change but lengthening the response window creates a risk around volume of work that becomes difficult to manage (i.e. 10 eConsult per day, becomes 30 every third day).
- Extended response times do not drive usage – patients will consider their means of access based on the benefits to them. eConsult have witnessed in every practice that has historically had an extended response window that they have also had significantly lower level of patient uptake.
- eConsult data shows that approximately 71% of practice respond to eConsult queries on the same day.
- The response window is to inform patients that the practice is dealing with their query. Patients do not require a resolution by this point but need to be assured that an appropriate clinician has reviewed and considered the risks of delaying (i.e. post a clinical review, a GP feels it is better for the patients named GP to review the consultation. This message gets passed back to the patient. The patient’s expectations have been managed and the practice can be confident the clinical risk has been appropriate considered).
- Practice can shorten their response window to reflect their chosen delivery model.
How does the practice cap, pause, or switch off the online consultation function? What is the process for a practice to do each of the above? Who do they contact? How long will it take to action?
- The consultation engine of eConsult can be switched off at the weekends. This can be requested via eConsult’s operation teams with a maximum 14-day turn-around time.
- This will not be conducted for practices at launch. Practices often view to control volumes – but data shows this does not happen. Patient satisfaction is typically lower for these practices as patients need to “think” about when to use the platform.
- To date, only practices that are using eConsult for a “total triage” model of care has switched off the consultation engine at the weekends.
- Demand levels are typically driven by the practice. Unless actively directed to use the platform, patients are unlikely to end masse. Therefore, practices have a high level of control as to the volume of eConsult traffic
Do eConsult have an automated way of tracking the status of an open query which will alert the receptionist if a doctor for instance has/has not closed a query?
- eConsult do not have an automated tracking method to see if a query has been responded to or not. It would be impossible to monitor with so many ways practices can respond to patients (Calls, F2F appointments, Texts, one-way messaging service). The key is to make sure when an eConsult comes in, it gets put into an appointment book, so the clinician knows they have an eConsult to review.
- After a clinician has responded to the patient (in whatever way practice has decided works best for you) it is important to keep that in the patients record as you would with anything else.
- If the "End of the next working day" passes, and the patient feels they have not got a response from the practice, they can go to the confirmation email they got when they submitted the eConsult and send a nudge to the practice which says "I have not received a response to my eConsult"
Can practices change the description in the boxes on the website banners?
- Practices can recommend alternative banner wording to eConsult. However, practices cannot tailor the descriptions for each practice. The wording was chosen based on the most common presenting symptoms or conditions. 80% of patients visiting eConsult had one of the conditions in the first box.
Can practices switch off the paediatric content to disable any paediatric queries?
- Yes. Practices can remove the paediatric questions section if they feel their patient population is mainly adults.
What other online tools should practices be using to support video consultation?
- We are aware that a number of practices are currently using AccuRx to deliver video consultations. AccuRx has been nationally funded for the immediate response to COVID-19 for an initial three-month period through to the end of June 2020. All practices that use the AccuRx video solution between these dates will be covered by this national contract. We will update you on plans for video solutions post-June in the coming weeks.
- For those practices who have eConsult in place for online triage, they have also offered a video solution through their partnership with Q-Doctor, and we will continue to work them to improve this video offer in the coming months.
- SystmOne and EMIS also both offer video consulting in their systems.
How does a practice check the patient is registered at the practice?
- eConsult includes a section for the user to confirm they are registered at the practice before they complete an online consultation. Practices should follow their current procedure if they receive telephone calls from patients that are not registered at their practice.
- We suggest directing patients to download the NHS App which utilises the national NHS Login verification and ensures that patients are registered at your practice.
What happens if the patient submits an eConsult to a practice they are not registered to?
- eConsult have mitigated against the risk of non-registered patients using eConsult as much as possible. For those who utilise the NHS App / NHS Login, the system will alert the user if there is a mismatch with the registered practice held within the patient demographic service. For patients using the ‘Guest’ login, there is a confirmation question confirming the practice details and whether they are registered at the surgery. There are rare instances where patients may still submit an eConsult having circumvented these mitigations and the practice discover that the eConsult report belongs to an unregistered patient. In this instance, eConsult strongly recommend GP practices hold a standard operating procedure in place in that the eConsult report is still reviewed and the patient is contacted to determine if immediate treatment is necessary and they should be seen as a temporary patient or signposted to their own practice or alternative service as appropriate. This is analogous to an unregistered patient phoning the surgery or walking into reception requesting medical advice - practices do have a duty of care to determine the nature of the request and advise accordingly.
Patient verification and identification
What is the process for eConsult patient identification and verification: What is the current process for patient identification and verification? When will automated identification and verification be available?
- Automated identification and verification is available via the NHS App which utilises the NHS Login verification process.
- For eConsults submitted via the practice website, patient verification is undertaken via vouching (much the same as would be required when conducting a telephone consultation). Before sensitive PID is shared with a patient, a couple of identifier questions should be posed to the patient (i.e. when did you last visit the practice, what was the reason for that visit etc.)
- NHS Login verification will be introduced to practice websites in the coming months.
Patient safeguarding and security
Why have patients been sent to NHS 111 if they have used eConsult for hip pain?
- The algorithm looks out for red flags. If the patient records a high pain mark (such as an 8) then the patient will be signposted to alternative NHS services, such as NHS 111.
Has the algorithm been changed for COVID - are the red flags more sensitive?
- If patients say that they have COVID then they will be signposted to NHS 111. However, the algorithm has not been changed to be more sensitive, the red flags are the same as before COVID.
Is there security in the system to monitor abuse for inappropriate images being uploaded?
- eConsult has security restrictions on the types of files that can be uploaded (to ensure its only images) but they do not perform any kind of analysis of the images themselves to check if they are inappropriate. There has been no report of inappropriate images being uploaded.
How many significant events have there been since using the eConsult system?
- eConsult have had over 500,000 online consultations over the period and there have not been any significant events.
Is there a way for the eConsult system to facilitate continued correspondence if the clinician wants that?
- If further communication is required then the practice will need to contact the patient directly via phone call, text message or email.
Can practices disable the question allowing patients to be 'seen/reviewed' by a specific doctor?
- Yes, practices can remove this question. Not many patients answer this question but if the practices do not want then you they can ask eConsult to remove it.
Can practices have more than one signposting to local services?
- No, if signposting is requested, eConsult will allow signposting to one local service per condition.
If for example a patient is signposted to 'talking therapies'. Will there be an expectation they will get a response by the end of the next working day?
- When patients are sign posted to local services, they will be informed about the process and expectation of the local service. This will normally be different to eConsult response times.
How useful has the self-help section of the solution been for patients? Is there some cause for concern around the content?
- The self-help information is the same advise provided on the NHS Choices website. The option the patient chooses is entirely on patient’s choice to use self-help.
Is the funding only for a certain number of online consultations?
- Funding covers all registered patients to submit any number of online consultations.
How was the description in the website banner chosen?
- "The first box takes the patients to a template about the conditions described (mental health etc). These conditions are what 80% of patients using eConsult have presented with.
- The second box is around symptoms - patients may not know what is wrong with them but they are experiencing those symptoms.
- The third is administrative, GP have asked for that to be about repeat prescriptions but eConsult does not offer this. The NHS app will offer this, and they don't want to duplicate steps
- The final box is for paediatric questions - this can be removed but is helpful for parent/careers to quickly ask for help/support to look after their child "