How patients experienced an online GP consultation system

Why it matters

Online consultation systems (OCSs) are ways in which patients contact their healthcare team online – by filling out forms either with text or multiple-choice questions. Doctors and nurses can respond through messages, phone calls, video calls, or by arranging in-person visits.

Since 2020, OCSs have been widely adopted in primary care due to policy changes and the COVID-19 pandemic. During the pandemic, GP practices were instructed to use ‘Total digital triage’ where all initial patient contacts were made via an OCS as the first point of contact. By May 2020, 85% of GP practices in England were using them, and of those, 72% of patient requests were made through OCSs.

Most research on OCSs was carried out before COVID-19 and focused on clinicians rather than patients. Studies that looked at patient experiences often used surveys, and these tended to not have much participation, especially among younger patients. Since the number of practices using OCSs has grown significantly, there is now a need for more in-depth research on how patients experience these systems. In this study, we aimed to find out why patients chose to use an OCS, when they preferred to use it, and what they thought made it easier or harder for them to use it.

This study was the largest ever reported qualitative study of patient experiences using an OCS and provides helpful insight into why some patients prefer in-person consultations, and why others prefer to use an OCS.

What we found

We looked at Patchs – an OCS which patients access via their GP practice’s website to ask for advice about health issues or make administrative requests like getting a fit note (evidence about their fitness to work, given by their healthcare provider) or medication.

Patients describe their health issues in free text, using a chatbot (a computer programme designed to ask questions, mainly over the internet) which asks 4-6 questions (the number depends on the type of request). These questions include a description of the request and patients’ ideas, concerns, and expectations. GP staff aim to respond within a set time via message, phone/video call, or by arranging an in-person appointment.

Most patients found OCSs better than traditional ways of contacting their GP, especially for minor issues like rashes or colds. They liked the convenience and flexibility of using OCSs, which was particularly helpful for people with full-time jobs or childcare responsibilities, and felt that they were faster, more flexible, and more efficient than traditional methods.

The biggest advantage was getting a quicker response compared to waiting longer for an in-person appointment – patients believed the OCS saved time, bypassing busy phone lines to reception, avoiding unnecessary travel and long waits in-surgery due to delayed appointments. Another perceived plus was that people were able to provide their GP with detailed information about their health conditions and questions in advance, which saved time if a telephone or in-person consultation was necessary.

However, some people still preferred to contact their GP by phone or in person, and how GP practices used the OCS varied widely, which affected patients’ experiences. Poor communication about the OCS and a lack of signposting left some people feeling frustrated, and in some practices OCS were not made available to everyone by their practice, due to a fear of being inundated with requests. Some patients found the OCS itself confusing, especially if there were other online options available to, for example, order medication. Some patients didn’t realise that in-person appointments would be offered if necessary, and others thought the OCS was just an in-person appointment booking service.

Some patients were worried that important information given to doctors over the telephone or in-person was easily overlooked, and that using an OCS was safer as everything was recorded. 

A minority of patients worried that using the OCS put a responsibility onto them to make sure they shared enough, and appropriate details about their concerns. They worried that losing the non-verbal cues and physical context of an in-person appointment might lead to serious issues bring missed.

Many patients liked being able to write a free text message to their GP practice through the OCS, with some feeling more comfortable discussing sensitive issues online, although others preferred face-to-face conversations. Patients who had trouble speaking during traditional consultations found the OCS easier to use, but those with attention disorders found it harder. Men were more likely to use the OCS, and many older patients said that they also found it user-friendly.

Using our findings, we have made some recommendations for GP practices and OCS designer about ways they might optimise patients’ experience when using OCSs –

• Recommendations for GP practices using online consultation systems to optimise patient experience
• Recommendations for online consultation system designers to optimise patient experience

More research is needed to understand why some patients chose not to use it.