Background: Timely access to neurosurgeons for clinical advice is limited depending on region and other social factors. An eConsult service providing access to neurosurgeons in Ontario, Canada may influence primary care provider (PCP) course of action and referral behaviours. Methods: The Champlain BASE (Building Access to Specialist Care via eConsult) service allows PCPs to access specialist care in lieu of traditional face-to-face referrals. We conducted a cross-sectional study of eConsult cases submitted to neurosurgeons by PCPs between Jan 1, 2017 and Dec 31, 2018. Usage data and PCP responses to a mandatory closeout survey were analyzed. Results: A total of 432 eConsults were submitted. Specialist median response time was 2.29 days with 86.8% of responses occurring within 7 days. PCPs received a new or additional course of action in 53% of cases. An unnecessary face-to-face referral was avoided in 57% of all eConsults, and 50% of cases where the PCP initially contemplated requesting a referral. Over 86% of cases were rated at least 4 out of 5 in value for PCPs and their patients. Conclusions: The use of eConsult improves access to neurosurgeons by providing timely, highly-rated practice-changing clinical advice while reducing the need for patients to attend face-to-face office visits.