Digital dreams, uncomfortable truths

How many times have you heard the promise that patients will self care with health apps and websites instead of bothering their GP?  And then compared the promise with the daily reality of demand slowly, steadily ratcheting up?

I wrote The Diversion Myth over a year ago and I’m glad to say we can revisit it with our own real data.  We’ve never claimed that our askmyGP online access platform would divert demand away from GPs, but we’ve said there may be potential and we’ve been trying very hard to prove it.  Every welcome page links directly to the excellent NHS Choices site, and we go further:  having entered their symptoms, patients are invited with one click to go straight to the relevant NHS Choices page.  Perfectly tailored patient education!

Since adding the tailored links, the results are:

16,710 total patient submissions

4,458 links presented

519 links visited

10 patients decided not to consult.

One of them was me, with a throbbing earache, discovering to my delight that antibiotics were not advised and it should clear up within 3 days.  It did.

Friends, this isn’t going to work.  I was hoping for perhaps 5% diversion.  2% would have disappointed.  0.06% is so tiny that even with brilliant optimisation multiplying the effect by a factor of 10, it would reach a barely perceptible 0.6%.

What we have shown is that patients are keen to seek help online.  Fears of a deluge of trivia are unfounded, you need to beg them to use it, but so long as they get the message from a trusted GP and they get a rapid response, 20% will shift from phone to online.  It’s then easier and less frustrating for patients and practice to manage demand.  I don’t think that is impressive, compared with 80% online say for travel bookings, but it’s promising and we are working on how to build that to over 50%.

I’ve explored the challenges and the reality for digital primary care in a poster at last week’s EFPC conference:

How can digital access promote efficiency and equity?

Interested in your views on this.

Dr Sara Cowell


PS Our competitors webGP are still claiming 18% of patients self managed an issue for which they “planned” to consult, indeed that “60% of patients were able to resolve their health concern without a visit”, implying they did so themselves.  Strangely, we never see any numbers.  Does anyone independent out there using webGP have any evidence of overall demand reduction?

3 responses to “Digital dreams, uncomfortable truths”

  1. Dr Michael Rosser says:

    Do you give every patient seen a hand out with simple relevant directions to access the online facility. ?
    Might increase uptake over time.

    • Dr Sara Cowell says:

      Yes, we have a beautiful leaflet to give out. But it makes little difference compared with a GP message on the phone at the time of need.

  2. Tony Kelpie says:

    It is necessary to be clear about what problem(s) we are trying to solve.
    Access to information online can be helpful, especially to those who have the confidence to make their own decision once they have the information.
    Access to information may help GPs too, but also depends on them having confidence.
    Confidence may be built over time - sometimes quickly, more often slowly.

    Patients phoning a practice are a selected group- anxiety being their main common feature. It is necessary for anxiety to be reduced and confidence built if they are to avoid the ‘need’ for further contact.

    Direct telephone advice is currently much more effective in managing workload- but only if it is focussed on reducing anxiety and increasing capability and confidence for self care. Effective telephone advice will also include accurate diversion to other services, and the arrangement of face to face consultation when needed, with urgency or convenience as appropriate.

    Online access cannot be available in an equitable fashion for the foreseeable future. Telephone is almost universally available and is therefore the closest to equity that we can get at present

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