{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:53:01Z","timestamp":1782845581967,"version":"3.54.5"},"reference-count":53,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Public Health Surveill"],"abstract":"\n Background<\/jats:title>\n The National Health Service (NHS) Long Term Plan, published in 2019, committed to ensuring that every patient in England has the right to digital-first primary care by 2023-2024. The COVID-19 pandemic and infection prevention and control measures accelerated work by the NHS to enable and stimulate the use of online consultation (OC) systems across all practices for improved access to primary care.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We aimed to explore general practice coding activity associated with the use of OC systems in terms of trends, COVID-19 effect, variation, and quality.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n With the approval of NHS England, the OpenSAFELY platform was used to query and analyze the in situ electronic health records of suppliers The Phoenix Partnership (TPP) and Egton Medical Information Systems, covering >53 million patients in >6400 practices, mainly in 2019-2020. Systematized Medical Nomenclature for Medicine\u2013Clinical Terminology (SNOMED-CT) codes relevant to OC systems and written OCs were identified including eConsultation. Events were described by volumes and population rates, practice coverage, and trends before and after the COVID-19 pandemic. Variation was characterized among practices, by sociodemographics, and by clinical history of long-term conditions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Overall, 3,550,762 relevant coding events were found in practices using TPP, with the code eConsultation detected in 84.56% (2157\/2551) of practices. Activity related to digital forms of interaction increased rapidly from March 2020, the onset of the pandemic; namely, in the second half of 2020, >9 monthly eConsultation coding events per 1000 registered population were registered compared to <1 a year prior. However, we found large variations among regions and practices: December 2020 saw the median practice have 0.9 coded instances per 1000 population compared to at least 36 for the highest decile of practices. On sociodemographics, the TPP cohort with OC instances, when compared (univariate analysis) to the cohort with general practitioner consultations, was more predominantly female (661,235\/1,087,919, 60.78% vs 9,172,833\/17,166,765, 53.43%), aged 18 to 40 years (349,162\/1,080,589, 32.31% vs 4,295,711\/17,000,942, 25.27%), White (730,389\/1,087,919, 67.14% vs 10,887,858\/17,166,765, 63.42%), and less deprived (167,889\/1,068,887, 15.71% vs 3,376,403\/16,867,074, 20.02%). Looking at the eConsultation code through multivariate analysis, it was more commonly recorded among patients with a history of asthma (adjusted odds ratio [aOR] 1.131, 95% CI 1.124-1.137), depression (aOR 1.144, 95% CI 1.138-1.151), or atrial fibrillation (aOR 1.119, 95% CI 1.099-1.139) when compared to other patients with general practitioner consultations, adjusted for long-term conditions, age, and gender.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n We successfully queried general practice coding activity relevant to the use of OC systems, showing increased adoption and key areas of variation during the pandemic at both sociodemographic and clinical levels. The work can be expanded to support monitoring of coding quality and underlying activity. This study suggests that large-scale impact evaluation studies can be implemented within the OpenSAFELY platform, namely looking at patient outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/46485","type":"journal-article","created":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:04:47Z","timestamp":1690243487000},"page":"e46485","source":"Crossref","is-referenced-by-count":9,"title":["The Use of Online Consultation Systems or Remote Consulting in England Characterized Through the Primary Care Health Records of 53 Million People in the OpenSAFELY Platform: Retrospective Cohort Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3020-8112","authenticated-orcid":false,"given":"Martina","family":"Fonseca","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3786-9063","authenticated-orcid":false,"given":"Brian","family":"MacKenna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2098-1278","authenticated-orcid":false,"given":"Amir","family":"Mehrkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The OpenSAFELY Collaborative","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1882-0886","authenticated-orcid":false,"given":"Caroline E","family":"Walters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6691-4046","authenticated-orcid":false,"given":"George","family":"Hickman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7520-9659","authenticated-orcid":false,"given":"Jonathan","family":"Pearson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0295-3812","authenticated-orcid":false,"given":"Louis","family":"Fisher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7784-1719","authenticated-orcid":false,"given":"Peter","family":"Inglesby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6354-3454","authenticated-orcid":false,"given":"Seb","family":"Bacon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9890-3619","authenticated-orcid":false,"given":"Simon","family":"Davy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9162-4999","authenticated-orcid":false,"given":"William","family":"Hulme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5127-4728","authenticated-orcid":false,"given":"Ben","family":"Goldacre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7365-149X","authenticated-orcid":false,"given":"Ofra","family":"Koffman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6330-4867","authenticated-orcid":false,"given":"Minal","family":"Bakhai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2024,9,18]]},"reference":[{"key":"ref1","unstructured":"Digital first primary careNHS England2022-10-28https:\/\/www.england.nhs.uk\/gp\/digital-first-primary-care\/"},{"key":"ref2","unstructured":"The NHS long term planNHS England2019012022-10-28https:\/\/www.longtermplan.nhs.uk\/publication\/nhs-long-term-plan\/"},{"key":"ref3","unstructured":"TheNational Health Service (general medical services contracts and personal medical services agreements) (amendment) (no. 2) regulations 2023The National Archives2021-09-17https:\/\/www.legislation.gov.uk\/uksi\/2023\/449\/contents\/made"},{"key":"ref4","unstructured":"OC\/VC National Supplier Collection FutureNHS dashboard (internal use)NHS England20212024-04-29https:\/\/future.nhs.uk\/"},{"key":"ref5","unstructured":"BakhaiMThe use of online and video consultations during the COVID-19 pandemic - delivering the best care to patientsNHS England20202022-05-26https:\/\/www.nhsx.nhs.uk\/blogs\/use-online-and-video-consultations-during-covid-19-pandemic-delivering-best-care-patients\/"},{"key":"ref6","unstructured":"Delivery plan for recovering access to primary careNHS England20232023-06-16https:\/\/www.england.nhs.uk\/publication\/delivery-plan-for-recovering-access-to-primary-care\/"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n264"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2005.1.2.57"},{"key":"ref9","unstructured":"DiasAClarkeGHow are total triage and remote consultation affecting prescribing patterns?The Health Foundation2022-10-28https:\/\/www.health.org.uk\/news-and-comment\/charts-and-infographics\/how-are-total-triage-and-remote-consultation-affecting-presc"},{"key":"ref10","unstructured":"ClarkeGParizaPWoltersAHow are total triage and remote consultation changing the use of emergency care?The Health Foundation2022-10-28https:\/\/www.health.org.uk\/news-and-comment\/charts-and-infographics\/how-are-total-triage-and-remote-consultation-changing-the-us"},{"key":"ref11","unstructured":"Appointments in general practiceNHS England20212021-05-07https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/appointments-in-general-practice"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019966"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016901"},{"key":"ref14","unstructured":"Onboarding new users to OpenSAFELYOpenSAFELY20212021-05-07https:\/\/www.opensafely.org\/onboarding-new-users\/"},{"key":"ref15","unstructured":"OpenSAFELYBennett Institute for Applied Data Science2023-06-16https:\/\/www.opensafely.org\/"},{"key":"ref16","unstructured":"Patient online management information (POMI)NHS England20212021-05-07https:\/\/digital.nhs.uk\/data-and-information\/data-collections-and-data-sets\/data-collections\/pomi"},{"key":"ref17","unstructured":"The NHS digital SNOMED CT browserNHS England20172021-03-07https:\/\/termbrowser.nhs.uk\/?"},{"key":"ref18","unstructured":"FonsecaMOnline consultations (SNOMED)-v01: OpenSAFELY codelist builderOpenCodelists2022-05-07https:\/\/www.opencodelists.org\/codelist\/user\/martinaf\/online-consultations-snomed-v01\/28bba9bc\/"},{"key":"ref19","unstructured":"OpenSAFELY documentation - variable referenceOpenSAFELY2022-03-07https:\/\/docs.opensafely.org\/study-def-variables\/#cohortextractor.patients.with_gp_consultations"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0380"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.12688\/wellcomeopenres.16737.1"},{"key":"ref22","unstructured":"National statistics - English indices of deprivation 2019Ministry of Housing, Communities & Local Government20192023-06-16https:\/\/www.gov.uk\/government\/statistics\/english-indices-of-deprivation-2019"},{"key":"ref23","unstructured":"National segmentation resources to support health and care systemsArden&GEM20212022-10-28https:\/\/www.ardengemcsu.nhs.uk\/showcase\/news-events\/news-events\/national-segmentation-resources-to-support-health-and-care-systems\/"},{"key":"ref24","unstructured":"OpenSAFELY GitHub repositoryGitHub2023-06-19https:\/\/github.com\/OpenSAFELY"},{"key":"ref25","unstructured":"OS_OC_v001-research Github repositoryGitHub2023-06-16https:\/\/github.com\/opensafely\/OS_OC_v001-research"},{"key":"ref26","unstructured":"BETA: data security standardsNHS England20202020-04-30https:\/\/digital.nhs.uk\/about-nhs-digital\/our-work\/nhs-digital-data-and-technology-standards\/framework\/beta---data-security-standards"},{"key":"ref27","unstructured":"Data security and protection toolkitNHS England20202020-04-30https:\/\/digital.nhs.uk\/data-and-information\/looking-after-information\/data-security-and-information-governance\/data-security-and-protection-toolkit"},{"key":"ref28","unstructured":"ISB1523: anonymisation standard for publishing health and social care dataNHS England2020-04-30https:\/\/digital.nhs.uk\/data-and-information\/information-standards\/information-standards-and-data-collections-including-extractions\/publications-and-notifications\/standards-and-collections\/isb1523-anonymisation-standard-for-publishing-health-and-social-care-data"},{"key":"ref29","unstructured":"Coronavirus (COVID-19): notification to organisations to share informationSecretary of State for Health and Social Care - UK Government20202020-04-30https:\/\/web.archive.org\/web\/20200421171727\/https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-notification-of-data-controllers-to-share-information"},{"key":"ref30","unstructured":"OpenSAFELY: the coronavirus (COVID-19) research platformNHS England2023-06-16https:\/\/www.england.nhs.uk\/contact-us\/privacy-notice\/how-we-use-your-information\/covid-19-response\/coronavirus-covid-19-research-platform\/"},{"key":"ref31","unstructured":"Policies for researchersOpenSAFELY2023-06-16https:\/\/www.opensafely.org\/policies-for-researchers\/"},{"key":"ref32","unstructured":"BakhaiMCroneyLHenshallNUsing online consultations in primary care: implementation toolkitNHS England20202024-04-29https:\/\/www.england.nhs.uk\/publication\/using-online-consultations-in-primary-care-implementation-toolkit\/"},{"key":"ref33","unstructured":"Data-coding 8708 - TPP local codesBiobank2021-03-07https:\/\/biobank.ndph.ox.ac.uk\/showcase\/coding.cgi?id=8708&nl=1"},{"key":"ref34","unstructured":"eConsult tweet on new eConsultation codeeConsult20202021-05-07https:\/\/twitter.com\/econsult_thinks\/status\/1262284324038152193"},{"key":"ref35","unstructured":"NECS Clinical Systems Specialists TeamSystmOne - receiving and processing eConsult guideNorth of England Care System Support20202022-05-07https:\/\/web.archive.org\/web\/20210122134416\/https:\/\/learning.necsu.nhs.uk\/docs\/systmone\/receiving_and_processing_econsult_guide.pdf"},{"key":"ref36","unstructured":"BakhaiMAdvice on how to establish a remote \u2018total triage\u2019 model in general practice using online consultationsNHS England2020092021-05-07https:\/\/www.england.nhs.uk\/coronavirus\/wp-content\/uploads\/sites\/52\/2020\/03\/C0098-total-triage-blueprint-september-2020-v3.pdf"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X709937"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X710933"},{"key":"ref39","unstructured":"Statement on the fifteenth meeting of the IHR (2005) emergency committee on the COVID-19 pandemicWorld Health Organization2023-06-16https:\/\/www.who.int\/news\/item\/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic"},{"key":"ref40","unstructured":"Appointments in general practice: supporting informationNHS England2023-06-16https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/appointments-in-general-practice\/appointments-in-general-practice-supporting-information#appointment-mode"},{"key":"ref41","unstructured":"Appointments in general practice December 2020NHS England20212024-04-29https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/appointments-in-general-practice\/december-2020"},{"key":"ref42","unstructured":"GP patient survey 2021 analysis toolNHS England20212022-05-15https:\/\/www.gp-patient.co.uk\/analysistool"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.37361\/asm.2021.1.1"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X711365"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.3399\/BJGPO.2020.0179"},{"key":"ref46","unstructured":"Practice initiated review questionnaireseConsult20222022-10-11https:\/\/econsult.net\/customer-area\/primary-care\/features-how-to-use-econsult\/review-questionnaires"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-018-1639-5"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(17)32158-x"},{"key":"ref49","unstructured":"BakhaiMWorking as a GP through the pandemic: using online tools as part of a hybrid model of care to meet the needs of patients and staffThe Health Foundation20222023-07-18https:\/\/www.health.org.uk\/news-and-comment\/blogs\/working-as-a-gp-through-the-pandemic"},{"key":"ref50","unstructured":"ClarkeGDiasAWoltersAAccess to and delivery of general practice services: a study of patients at practices using digital and online toolsThe Health Foundation20222023-07-18https:\/\/www.health.org.uk\/publications\/access-to-and-delivery-of-general-practice-services"},{"key":"ref51","unstructured":"Network contract directed enhanced service: standardised GP appointment categoriesNHS England2022-05-15https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2021\/03\/B0486-network-contract-des-standardised-gp-appointment-categories-21-22.pdf"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0376"},{"key":"ref53","author":"Ellis, KB","journal-title":"arXiv"}],"container-title":["JMIR Public Health and Surveillance"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publichealth.jmir.org\/2024\/1\/e46485","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:53:06Z","timestamp":1782841986000},"score":1,"resource":{"primary":{"URL":"https:\/\/publichealth.jmir.org\/2024\/1\/e46485"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,18]]},"references-count":53,"URL":"https:\/\/doi.org\/10.2196\/46485","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.46485","asserted-by":"object"}]},"ISSN":["2369-2960"],"issn-type":[{"value":"2369-2960","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,18]]}}}