No more ‘please hold’: the NHS App and online triage are changing the way we make GP appointments

Over the past couple of months, Camden patients have picked up the phone to make a GP appointment only to find that things have changed. In addition to new Covid-safe arrangements such as telephone, email and video consultations, GPs have also implemented the so-called “online triage” (many already had this ‘live’ or in the pipeline before the Covid-19 crisis). Instead of booking an appointment through the receptionist, patients are now encouraged to use an NHS online system called e-Consult or other similar mobile phone Apps.

After registering for the online system and getting a personal password on first use, patients must then fill in and submit a short questionnaire indicating why they want to see a doctor. This is then reviewed by the practice before an appointment is offered and scheduled. Advocates of the system stress that it is not designed to prevent anyone from getting an appointment. The questionnaire is not intended as a means of eliminating patient requests, simply as a way of organising appointments more quickly and efficiently according to need. For GPs, the online triage system allows them to quickly review what sort of appointment might best suit the patient which speeds things up and makes better use of GP’s time.

For many patients, booking a GP appointment online has been a preferred option for some time. For others who may have resisted this change, the strong nudge towards online booking has encouraged them to try out a new process that they have then found to be simple and convenient. Some patients using the online e-Consult system have reported getting an appointment more quickly than before and appreciated not having to wait on hold when calling the practice.

Here’s what one Camden resident told us about her recent experience:

“I have been really impressed with the effectiveness of the online service. My son had a mental health emergency on a Saturday morning, and within two hours one of the doctors had rung us back. At what has been a very stressful time, I am extremely impressed with the efficiency of the service.”

Nevertheless, for some of those who still prefer to call their practice, the change has come as a bit of a shock. GP practices insist that patients who cannot use the internet are still able to call and talk to a receptionist. But people have been contacting Healthwatch Camden to express their concerns.

One teenage boy, confident with IT and internet use, followed the answerphone instructions at his GP practice and attempted to download e-Consult on his mobile phone. After several attempts he still found the system hard to use, lost confidence and gave up. Six weeks later he had still not managed to make a GP appointment for himself to discuss his mental health issues.

Another patient said:

My husband is [hard of hearing], found the recorded telephone message impossible to decipher. The speaker spoke far too fast, with poor clarity. He does not use the internet.”

Concerned at what we were hearing, Healthwatch Camden organised a team of community research volunteers to call 25 GP practices (out of 33 total) in Camden and report back on whether or not patients were being directed to an online triage system and, if so, the clarity of instructions given on the answerphone messages.

Some of the feedback that we received from our volunteers included:

“Voice recording is not very clear. Difficult to hear some parts of information.”

“Long [answerphone] message is a distraction.”

Around half of Camden’s GP practice answerphone messages are now giving details about how patients can use e-Consult as an alternative to waiting on hold to speak to a receptionist. However, among these, we found significant variation in the extent to which the messages are directing patients to the online triage as a first option. All the recorded messages did, at some point, advise patients that they could stay on the line to speak to a receptionist if necessary but in some cases this option was not clearly communicated.

Healthwatch Camden volunteers reported that in the case of some surgeries:

“The option [of making an appointment using the telephone] is provided at the end but this could be made clearer at the beginning.”

“You need to press a further number to connect to the reception team.”

“If you wait you are put through to reception. I think this could be made clearer when saying you can book appointments online too.”

In one example, the recorded message was so long and complicated that it was almost impossible to understand the options, leaving some callers feeling that there was no way they could contact their GP without going online. In another, the message did tell patients that they could stay on the line if they were unable to use the internet but the delivery of the message was rushed and poorly articulated so that it sounded as if you should only stay on the line only if you were experiencing a medical emergency.

In a third example, one caller who stayed on the line to talk to a receptionist was then told by the receptionist that appointments could only be made by downloading the mobile phone app. In this case, Healthwatch Camden contacted the GP practice manager immediately and learned that this was not the case. A new team member at the reception desk had misunderstood the guidelines and was misinforming patients. The matter was immediately rectified.

Healthwatch Camden has shared this feedback with the NHS commissioning body and has also contacted some practices directly to encourage them to improve their communication around the new systems and to make sure patients who are not able to use online access are not put off making a GP appointment if they need one. 

More of Camden’s GPs are expected to convert to using e-Consult in the coming months. While we welcome innovation that will improve the patient experience and make better use of GP resources, we will continue to argue that new online options for accessing care must not risk excluding patients who are unable or unwilling to use online platforms to book appointments at their GP practice.