Intended for healthcare professionals

Practice Practice Pointer

How to conduct written online consultations with patients in primary care

BMJ 2021; 372 doi: (Published 24 February 2021) Cite this as: BMJ 2021;372:n264
  1. Minal Bakhai, clinical director for Digital First Primary Care, general practitioner for NHS Brent CCG1,
  2. Helen Atherton, associate professor2
  1. 1NHS England and NHS Improvement London, Skipton House, London SE1 6LH, UK
  2. 2Warwick Medical School, UK
  1. Correspondence to: M Bakhai minal.bakhai1{at}

What you need to know

  • Have a blended approach to communication (using text, online message, phone, video, and face-to-face consultations) focused on patient need

  • Written online consultations work best in the context of an existing healthcare professional-patient relationship

  • Draw on your current skills and clinical acumen in conducting consultations and apply these when consulting online

  • The experience of the personal communication matters more to patients than the consultation modality

A written online consultation is a two-way written exchange between a healthcare professional and a patient using an online medium (such as an online web platform or email portal). Such exchanges offer an alternative route of access for patients alongside telephone and face-to-face consultations. This article offers a guide to help clinicians, particularly those working in primary care, use written online consultations effectively with their patients.

Where are written online consultations used in primary care?

Use of written online consultations has increased over the past decade, with many health systems adopting them as a way for primary care staff to interact with patients.1234 Arrangements for written online consultation vary between different countries and healthcare providers. In Denmark, offering patients email consultation has been mandatory in general practice since 2007, and 21% of all consultations were conducted this way in 2019.5 In England, general practices have been encouraged by NHS England and NHS Improvement to adopt online triage platforms. These offer patients a secure way to send a request or message to their practice via a structured online form.67 US health maintenance organisations have for many years used patient portals to facilitate this type of communication.89 The covid-19 pandemic has accelerated adoption of written online consultation because it offers communication without proximity.1011 Many primary care health professionals will now be encountering this form of consultation with patients for the first time.

What is the evidence base?

Evaluating online written consultations …

View Full Text

Log in

Log in through your institution


* For online subscription