Emails in primary care – pitfalls and positives

Patients often choose to email practices in the hope of receiving prompt answers to their medical queries. Dr Rachel Birch, Medicolegal Consultant at Medical Protection, offers some practical tips to help reduce risk and manage email contact safely.

The COVID-19 pandemic changed our lives in so many ways, not least the way patient care was delivered in general practice. Suddenly, and almost overnight, patients found themselves having to explain their symptoms over the telephone or during a remote consultation. As a result, many practices found that patients resorted to email, as they tried to seek medical advice.

Since general practices have eased restrictions, and face-to-face appointments have become more available again, many practices may find that patients prefer to continue to email them for clinical advice. However, this is not without its potential pitfalls, as the below case illustrates.

An unseen photograph

On Friday morning, Mrs S sent an email to the practice, asking for advice on her 5-year-old daughter’s rash – she wrote that her daughter had a high temperature and was off her food, and she sent a photograph of a widespread rash over her daughter’s chest and abdomen.

On Monday morning, the practice manager discovered the email and, on checking the out of hours correspondence, she could see that the patient, Miss PS, had been admitted to the paediatric ward over the weekend.

She telephoned Mrs S and was pleased to hear that PS was now home and recovering from a viral illness. However, Mrs S was annoyed that she had received no response from the practice on the Friday and proceeded to make a formal complaint.

Fortunately, the patient did not come to harm in this scenario, albeit the mother did have to seek advice from the out of hours service on the Friday evening. However, it is helpful to think of this case as a ‘near miss’ – an event that, in different circumstances, could have resulted in patient harm.

Practices should take steps to learn from such incidents and consider how to minimise any risk.

• Consider the use of one dedicated practice email address, rather than separate email addresses for each of the clinicians.
• Arrange for a robust rota for the administrative team to check the emails several times a day and ensure that arrangements can be made at short notice, for example in the event of staff sickness.
• Decide what the email address will be used for in your practice. For example, receiving repeat prescription requests, sending clinical photographs, requesting sick lines or conveying test results etc.
• Whatever you use email for, ensure that patients are advised of the purpose and also the limitations of the use of email. You may wish to advertise this by way of notices in the practice, on the website and telephone recordings.
• If the email is not intended to be used as an alternative to telephone or face-to-face appointments, make sure that all patients are aware of this.
• Consider the use of an automated email message back to patients, on sending their email, advising them of the limitations of the service and the times (eg weekends and overnight) when emails are not checked. You may also wish to consider providing contact details for the out of hours service and emergency department, as well as the telephone number for the practice and emergency telephone numbers.
• Ensure that all staff are trained in the use of emails and that you have a formal policy for its use.
• Ensure that your spam filter settings are such that patient emails can be received.
• Any email or text communication, received by or sent to patients, should be stored within the patient’s clinical record.
• Consider why patients may choose to contact the practice in this way. For example, are there delays in their getting through to the practice on the telephone? Do you need more administrative staff answering the phones at busy times? Would the addition of more telephone lines be of assistance? Does the practice have an answerphone message if patients are not able to get through to the practice, advising patients of the importance of dialling 999 in genuine emergency situations?
• If patients do use email to seek clinical advice, even if this is not its intended purpose, it is important that a member of the clinical staff reviews the email and ensures that the patient receives appropriate care.

If you have any specific queries regarding the use of emails in general practice, please do contact Medical Protection for further advice.