Why coding the modality of primary care consultations matters

Stephanie Drew; Benedict Hayhoe; Geva Greenfield; Azeem Majeed; Ara Darzi; Ana Luisa Neves

doi:10.3399/BJGP.2025.0581

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Why coding the modality of primary care consultations matters
Helen Atherton

Published on: 02 October 2025

Published on: (2 October 2025)
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Why coding the modality of primary care consultations matters
Helen Atherton, Professor of Primary Care Research, University of Southampton
Terminology matters
I agree that clinical coding is important and concur with Drew and colleagues.¹ I thank them for raising a crucial issue that must be addressed. It was something we recognised in a small study conducted in 2015 and published in 2018,² back when this was not the pressing issue it is today. I hope that this call to arms is heeded by those with influence.

When thinking about coding we also need to consider terminology. The authors highlight the discrepancy between the labels available for coding, and the reality. The Government and media have taken to calling online enquiry platforms ‘online booking’³ which belies their intention, which is most often to triage patients and direct them to the appropriate place or professional. Direct booking is a different thing. Coding consultations becomes difficult when it is not clear where the consultation begins, and when it ends using a different modality e.g. form submission leads to a telephone consultation.

For the purposes of my own research, which has examined both direct booking⁴ and online enquiry platforms,⁵ online triage tool is the terminology I feel best describes the process used by most general practices, different from directly booking an appointment online in a specified slot. Others choose to use the term ‘online consultation’ or as is common in Europe, ‘e-consultation.’ Wh...
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Terminology matters
I agree that clinical coding is important and concur with Drew and colleagues.¹ I thank them for raising a crucial issue that must be addressed. It was something we recognised in a small study conducted in 2015 and published in 2018,² back when this was not the pressing issue it is today. I hope that this call to arms is heeded by those with influence.

When thinking about coding we also need to consider terminology. The authors highlight the discrepancy between the labels available for coding, and the reality. The Government and media have taken to calling online enquiry platforms ‘online booking’³ which belies their intention, which is most often to triage patients and direct them to the appropriate place or professional. Direct booking is a different thing. Coding consultations becomes difficult when it is not clear where the consultation begins, and when it ends using a different modality e.g. form submission leads to a telephone consultation.

For the purposes of my own research, which has examined both direct booking⁴ and online enquiry platforms,⁵ online triage tool is the terminology I feel best describes the process used by most general practices, different from directly booking an appointment online in a specified slot. Others choose to use the term ‘online consultation’ or as is common in Europe, ‘e-consultation.’ Which term is used does not necessarily matter - consistency and consensus is needed both for coding and within the research community.

Ultimately, the chosen terms should best describe both the patient and GP experience, so that patients do not turn on the news and see that they can now ‘book online’ but find themselves using online triage forms when they are expecting to be seeing the GP in person later that day. Meanwhile the GP is filtering through requests that do not in any way fit the criteria for a direct booking process and receiving criticism for not having the capacity to safety deal with the requests for ‘booking’.

References

1. Drew S, Hayhoe B, Greenfield G, Majeed A, Darzi A, Neves AL. Why coding the modality of primary care consultations matters. Br J Gen Pract 2025;75(759):443.
2. Atherton H, Brant H, Ziebland S, Bikker A, Campbell J, Gibson A. The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study. Southampton (UK): NIHR Journals Library; 2018;6(20).
3. Triggle N. Every GP practice now has to offer online booking. BBC News. 2025. www.bbc.co.uk/news/articles/cjed4qvzjeyo
4. Atherton H, Eccles A, Poltawski L, Dale J, Campbell J, Abel G. Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study. J Med Internet Res. 2024;26:e51931.
5. Bakhai M, Atherton H. How to conduct written online consultations with patients in primary care. BMJ. 2021;372:n264.
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Competing Interests: None declared.