Article Text

Download PDFPDF

Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England
  1. Hannah B Edwards1,2,
  2. Elsa Marques3,
  3. William Hollingworth1,
  4. Jeremy Horwood1,2,
  5. Michelle Farr1,2,
  6. Elly Bernard4,
  7. Chris Salisbury5,
  8. Kate Northstone1,2
  1. 1 School of Social and Community Medicine, University of Bristol, Bristol, UK
  2. 2 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3 School of Clinical Sciences, University of Bristol, Bristol, UK
  4. 4 One Care Consortium, Bristol, UK
  5. 5 Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Kate Northstone; kate.northstone{at}


Objectives Evaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use.

Design 15-month observational study.

Setting Primary care practices in South West England.

Results 36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an ‘e-consultation’ (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30–50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice’s response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed.

Conclusions Use of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.

  • general practice
  • primary care
  • online consultations
  • e-consultations
  • evaluation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from


  • Contributors KN, JH, HBE, MF, JB, EM, WH and EB: were responsible for the study design and collection of data. KN, JH and EB: were responsible for study management and co-ordination. CS: was a project advisor throughout. HBE, KN, EM and WH: analysed the data. HBE and KN: drafted the paper. All authors: read, commented on and approved the final manuscript.

  • Funding This research is part-funded by the One Care Consortium and supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests EB is employed by One Care who part-funded the research. HBE, MF, EM, KN and JH are employed by CLAHRC West who received part-funding from One Care.

  • Ethics approval HRA (IRAS project ID: 204925; Protocol number: 2604; Sponsor: University of Bristol).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No further data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.