Dear Editor
This is a balanced and sensible set of suggestions, which should be welcomed.
But the article also perpetuates some myths about remote consulting that should be challenged and corrected before repetition makes them into persistent zombie beliefs.
The first is that remote consulting (online or by phone) consumes more GP time than traditional ways of handling patient requests. The 8% more time number has been widely repeated presumably by people who didn’t read the whole study (Newbold et. al.) or check any alternative analyses. To quote the study:
“The average duration of both telephone and face to face consultations decreased, but there was an overall increase of 8% in the mean time spent consulting by GPs, albeit with large uncertainty on this estimate (95% confidence interval −1% to 17%; P=0.088). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase.”
The key line here is “some practices experiencing a substantial reduction in workload” an observation for which there is a good explanation that has been widely ignored. The key issue is that implementing total triage or remote consulting requires significant changes to how GPs handle their patient requests. Just adding an online route or triage via phone does not, by itself, create much benefit: those implementation details are what drive the benefits. And the study, despite the observation that results and time saving varied a great deal, did not investigate the different implementation details.
In short, the idea that online or phone triage cost more GP time is not supported even by the original paper the number was mentioned in. We should not keep repeating it as a fact or it will become one of those zombie statistics that gains credibility by repetition and affects actual policy.
The other idea that is not supported by good evidence is that there should be much more use of video. This was widely assumed to be a good alternative to face to face appointments early in the drive to cope with Covid. But many online systems have offered video as one of many modes of consultation (alongside messages and phone calls etc.). The evidence so far says that almost nobody wants it when offered a choice. Some systems see fewer than 1% of patients choosing video or getting video (with <0.1% in some). In contrast the ability to send pictures is widely used with some systems reporting perhaps 8% of inline requests sending images. Video has been widely tested and found wanting.
So, to summarise, sensible suggestions to improve safety. But two zombie ideas that should not be repeated: online and phone triage takes more time and video is widely useful.
Sensible suggestions, but some myths that should not be perpetuated