Lauded online systems regularly shut down due to overwhelming demand

LMCs around the country are warning that online access is overwhelming GP practices which do not have the capacity to cope, simply opening ‘another lane’ on a packed motorway, finds Emma Wilkinson

One of the ambitions in the GP recovery plan, published earlier this month, was to make online requests easy and dependable. However GPs report they are no silver bullet.

This includes a practice highlighted as a case study in the recovery plan, which Pulse found actually has a four-week wait for routine appointments.

At least three LMCs have issued specific advice in recent weeks for practices to switch off their online consultation systems ‘at a minimum’ outside core hours and consider disabling them during the weekday as a response to ‘unmanageable and unsafe’ workload.

Surrey and Sussex LMC issued the recommendation in response to the imposed contract after concluding the system does not have enough resources to provide a quick and safe service.

As of last week (15 May) practices must, under the imposed contract, offer patients an assessment or signpost them to an appropriate service ‘on first contact’, whatever route that may be.

Leicester, Leicestershire and Rutland LMC also urged practices to turn off online access outside core hours and at other times ‘you need to consider when safe capacity has been exceeded, and when as a practice you are unable to guarantee further safe same-day urgent care, in which case your online platform needs to be switched off until the following morning’.

Cambridgeshire LMC has given the same advice adding that practices should tie the decision to switch off online systems into their weekly/daily GPAS assessment.

Dr Abbie Brooks, a GP partner at the Priory Medical Group in York, who were included as a case study in the recovery plan for the use of their Klinik-based online consultation system said they moved in January from 24/7 patient access to the system only being switched on Monday to Friday 5am to 6pm.

The decision was made in response to overwhelming pressures on the Monday team faced with a deluge of requests. It hasn’t lessened the demand necessarily but has spread it out more over the week, she says.

For them the online system – through which all contacts with the practice are filtered – has meant the practice is now coping where it once struggled but it is absolutely not a silver bullet she stresses and has to be done with a lot of planning and whole system change.

‘Our current routine wait for appointments is four weeks. In an ideal scenario you would have another five GPs in every day which would push routine down to two weeks.

‘We can either offer quick urgent access or have the urgent care capped and have all appointments in two weeks. You can’t do it all at 100%.’

Dr Brian MacGregor, medical secretary at YOR LMC, said the Klinik software had had a mixed reception in practices in York that were using it.

‘But it certainly isn’t addressing the demand issues and is literally another lane on the motorway of patient access increasing demand on practices.

‘We have one practice in York that suffered a detrimental CQC assessment following a massive rise in demand through the AskMy GP app a few years ago and led to quite marked problems.

‘Most practices are switching the online consulting off overnight and outside of contracted hours, due to the excessive demand that this form of interaction drives.’

Fundamentally politicians seem to think there is unlimited capacity within general practice and continue to seek ways to increase access – which has already grown 20% from pre-pandemic levels, he says.

The focus should be on safe working practice, available capacity and hours of GP provision, he adds.

‘We simply have to stop promising more when there is no more to give.’

A Google search done by Pulse on a Thursday lunchtime of practices with Klinik systems very quickly identified a dozen that had limited themselves to in work hours, temporarily turned their systems off for lunch, limited online access to the morning only, disabled it until the next day or in two cases turned it off for weeks.

Dr Michael Mullineux, a GP in Maidenhead in Berkshire, said they had turned their e-consult off completely after demand became ‘untenable’.

‘I am of the view that switching systems on and off is unsatisfactory and liable to cause confusion and dissatisfaction amongst our patients.

‘We pointed out clearly at the outset that if we used e-consult, we would replace some of our standard phone and face to face appointments with these because our appointment availability was already well beyond standard recommended safe levels.

‘It rapidly morphed into a monster clogging up our inboxes and the expectations shifted to dealing with these in addition to other appointments, so further stretching well documented finite GP resources.’

He says younger generally healthier patients were using the option as a short cut while often older patients with significant medical problems were missing out.

Where they do use online access it is through clinician-generated invite rather than the absolutely insatiable public demand that current politically driven proposals are set to worsen substantially’. 

Dr Rob Barnett, medical secretary of Liverpool LMC said e-consultations have exacerbated an already problematic situation and they have said they will support any practice who turn off their systems when they have reached capacity as many are now doing.

In his practice, they were very concerned about safety because people were using e-consultation for urgent things, for young babies and to list five or six problems at once.

‘I’ve heard of situations where a GP has been taken off dealing with face to face to deal with patients online.’

GPs in Cheshire and Merseyside are now seeing a new system rolled out in phases called PATCHS, which was procured by the ICB. That in itself is an adjustment to if you were used to a different system, he notes.

‘There is only a certain amount of work people can do and you’re conning people if you think e-consultation is the way forward.’

NHS England national director for primary care Dr Amanda Doyle, who is leading on the implementation of the GP recovery plan, told HSJ that only 10-15% of GP practices are currently estimated to have implemented digital phone systems; online messaging; and modern triage, response and care navigation.

Meanwhile, 3,000 practices had digital phone systems while 3,500 were still on analogue systems, according to a November 2022 NHS England survey.