The original requirement for online consultations allowed for all patients to have access to online consultations by April 2020 and video consultation* by April 2020.
As part of the response to Covid-19, national guidance to enable all practices to move to a total triage model to protect patients and staff from avoidable risks of infection meant the process was accelerated. Total triage means that every patient contacting the practice is first triaged before deciding what steps need to be taken to support that patient. Total triage is important to reduce avoidable footfall into practices and protect patients and staff from the risks of infection. While total triage can be carried out entirely by telephone, this is less efficient than using an online consultation system to support the triage process. GP preparedness letter (including Annex D) published by NHSE on 27th March 2020.
Progress in Oxfordshire
Online consultations allow people to contact their GP practice without having to wait on the phone or take time to come into the practice. Online consultations enable patients to use a secure online system to ask questions, report symptoms and upload photos. The practice then looks at the request and responds within a stated timeframe, signposting the patient to the right person, service or support. Currently, practices use either an online triage system or a questionnaire-based system, with their own staff delivering the service.
The CCG had already procured eConsult for online consultations and this solution is currently funded. In Oxfordshire we fortunately were ahead of the curve with many practices already live with an online consultation system in place. As at 30th April 2020, 99% of our practices have an online consultation system in place with 76% of those using eConsult. Some practices chose to use an alternative supplier from the DPS framework, and will have funded those themselves.
*Part of the national guidance was that it is also essential that all practices have a video consultation system to support remote management of patients. Advice from NHSX on using free solutions has been published; all relevant products on the Digital Care Services Framework (GPIT Futures) have now been assured, and the rapid procurement via the DPS has also created an approved video consultation supplier list. Video consultation systems from the DCSF or DPS will be centrally funded for now. There are a variety of options available for practices to use and most practices in Oxfordshire have adopted AccuRx to meet the requirement. eConsult also have a solution called QDoctor and Emis have a video solution via Patient Access.
Using a different provider
Some practices in Oxfordshire are using different systems to provide online consultations. The national guidance advises purchasing an online consultation solution via the Dynamic Purchasing System (DPS) framework**. This guidance is there because the framework provides an extra level of protection and assurances as suppliers not only have to meet the technical specification, but also pass a number of checks and meet regulatory standards. However, if you are looking at a company outside of the DPS then we would advise you have a conversation with the national team at: email@example.com or firstname.lastname@example.org who can advise on whether it has the right functionality to meet online consultations and what to consider.
If practices do decide to procure a system that has not been approved, the supplier needs to demonstrate how they achieve quality assurance requirements in line with standard DCB0160 which usually requires the expertise of a clinical safety officer. Please refer to the full toolkit for more details.
**Information on current DPS approved companies
Please note OCCG will not make any financial contribution towards any other system so this will be at the cost of the practice.
A national implementation toolkit is available (193 pages). This comprehensive guide provides a range of ideas and options for different professionals, including clinicians, at different points in their implementation journey.
Following feedback the national team have produced a much shorter simpler toolkit (93 pages) for practices on implementing online consultations. It has been broken down into sections so practices can focus on different areas, so hopefully more manageable. It references the main toolkit if a particular question requires more detail.
An evaluation form is also available as a downloadable template. This can be used by GP practices to support them in measuring the impact of online consultations as a whole, from a clinician and patient perspective.
For further information contact Niki Roberts, Primary Care Project Manager
The OCCG contact at eConsult is Adina Alexa