The use of online consultation tools for common mental health conditions in UK primary care: a qualitative interview study of patient and practitioner perspectives

Background:
UK general practices are now required to make online consultation tools available during practice hours. Evidence shows patients increasingly use them to access mental health support under the ‘digital first’ approach. Whilst they may increase time-efficiency for practices, we do not know whether practitioners and patients view them as a suitable consultation mode to discuss mental health. Our aim was to explore patients’ and practitioners’ views and experiences of using online consultation tools for mental health, to inform their future use.

Method:
In-depth interviews with 20 primary care practitioners and 21 patients. A topic guide was used to ensure consistency across interviews. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. There was patient and public involvement throughout.

Results:
Patients and practitioners said online consultation tools encouraged reflective thinking about mental health and symptom disclosure. However, patients’ concerns around who might read the output meant they only provided limited information. Patients also reported online tools can be a barrier to accessing care, and those with less mental health literacy may struggle to articulate their concerns. Practitioners noted that continuity of care can be reduced when using online tools, and triage is more challenging if insufficient information is provided to determine if urgent care is needed.

Conclusion:
To ensure that online consultation tools do not increase inequity, they should remain part of a range of options for accessing mental health support in general practice and should not be a mandatory first step to access care. Online consultation tools can provide useful information for practitioners and may be more accessible than a telephone call for patients with anxiety or depression. However, practitioners may struggle to assess patient risk using these tools, which could mean patients do not receive the care they need. Patients might need support when first using online consultation tools and advice on who will access the information provided.