The remote care revolution during Covid-19

What does the rapid adoption of digital technology for delivering NHS care mean for patients?

QualityWatch is a joint research programme from the Health Foundation and the Nuffield Trust

Before the pandemic, compared to face-to-face appointments, patients who had a general practice appointment on the phone were…

2% less likely to have their needs met

4% less likely to say the health professional gave them enough time

4% less likely to feel that the health professional recognised and/or understood any mental health needs

Source: NHS England, GP Patient Survey

The pandemic has caused a rapid shift towards more health care being provided remotely, via telephone or video calls.

As the number of appointments in general practice fell, the proportion that took place remotely increased.

The number of appointments in general practice plummeted during the first wave of Covid-19, falling by 8 million between February and April.

Appointments in general practice carried out via telephone or video/online rose from 15% in February to 48% in April, decreasing slightly to 36% in October.

Source: NHS Digital, Appointments in General Practice

Notes: Experimental statistics and impacted by Covid-19 from March onwards

The proportion of outpatient attendances that took place by telephone or telemedicine increased too.

The number of outpatient attendances also plummeted, falling to 3.5 million between February and April.

Outpatient attendances taking place via telephone or telemedicine increased from 4% in February to 35% in April, falling to 25% in September.

A higher proportion of follow-up attendances now take place remotely than is the case for first attendances.

In the summer, most people said they would be comfortable attending a remote appointment.

68% of people said they would be ‘comfortable’ or ‘very comfortable’ attending an online appointment when asked in August 2020.

Certain groups felt slightly less comfortable:

Those with a specific health condition

Those aged 70+

Source: Office for National Statistics, Coronavirus and the social impacts on Great Britain

And most GPs feel that greater use of remote care should be retained in the longer-term...

In June, 95% of surveyed GPs provided remote consultations for their patients.

88% felt that greater use of remote care should be retained in the longer-term.

Source: British Medical Association, COVID-19: analysing the impact of coronavirus on doctors

Do remote appointments lead to different courses of action?

Prescribing of new medication is now more common in remote GP appointments.

It is unclear whether this signals a permanent shift in GPs’ prescribing habits.

GPs may be more cautious and prescribe medication ‘just in case’ as they adapt to the change in mode of appointments.

Or there may have been a shift in 'case mix', with more patients with new diagnoses accessing remote appointments and requiring prescriptions.

Source: Health Foundation analysis of CPRD data, re-used with permission. Additional analysis using the same data set is available here.

The rate of GP referrals to consultant-led care has shifted and is now higher for remote GP appointments.

Referrals to consultant-led outpatient care decreased dramatically in March.

As the first lockdown was easing in the summer, the rate of referrals was higher for remote GP appointments, exceeding pre-Covid levels.

GPs may be more cautious of their clinical conclusions in remote appointments and so refer on more patients – but it may also relate to the type of patient accessing different modes of care.

Source: Health Foundation analysis of CPRD data, re-used with permission of the Health Foundation.

The proportion of outpatient attendances that result in a patient being discharged is lower for remote than for face-to-face appointments.

Face to face

Telephone or telemedicine

Appointment to be made at a later date

Another appointment given

Discharged from consultant's care (last attendance)

Not known

For telephone and telemedicine appointments, the proportion of patients discharged fell from 25% in February to 18% in April, where it remained through to September.

The proportion of appointments where another needs to be made at a later date is higher for remote than for face-to-face appointments.

This could result in increased demand for appointments in an elective care system where there is already a growing waiting list.

What does this mean for quality?

The Covid-19 pandemic has dramatically changed the way patients access general practice and outpatient appointments, with far more telephone and video appointments being offered.

During the summer, people generally reported feeling comfortable attending remote appointments. This may be partly related to the pandemic: during these months, people were told to reduce social contact and were fearful of contracting the virus. Time will tell if this lack of preference will be maintained.

Increased rates of new prescriptions and GP referrals from remote appointments, alongside a decrease in outpatient appointments leading to a discharge, are concerning. These factors could compound each other, resulting in higher demand for care and even longer waiting times.

The rise in remote care has been radical, and more research is needed to determine the impact on clinical practice and patient safety, and the implications for NHS capacity.

The remote care revolution during Covid-19

What does the rapid adoption of digital technology for delivering NHS care mean for patients?

Before the pandemic, compared to face-to-face appointments, patients who had a general practice appointment on the phone were…

The pandemic has caused a rapid shift towards more health care being provided remotely, via telephone or video calls.

As the number of appointments in general practice fell, the proportion that took place remotely increased.

The proportion of outpatient attendances that took place by telephone or telemedicine increased too.

In the summer, most people said they would be comfortable attending a remote appointment.

And most GPs feel that greater use of remote care should be retained in the longer-term...

Do remote appointments lead to different courses of action?

Prescribing of new medication is now more common in remote GP appointments.

The rate of GP referrals to consultant-led care has shifted and is now higher for remote GP appointments.

The proportion of outpatient attendances that result in a patient being discharged is lower for remote than for face-to-face appointments.

What does this mean for quality?

GP referrals

Cancelled operations

Cancer waiting times

The remote care revolution during Covid-19

What does the rapid adoption of digital technology for delivering NHS care mean for patients?

Before the pandemic, compared to face-to-face appointments, patients who had a general practice appointment on the phone were…

The pandemic has caused a rapid shift towards more health care being provided remotely, via telephone or video calls.

As the number of appointments in general practice fell, the proportion that took place remotely increased.

The proportion of outpatient attendances that took place by telephone or telemedicine increased too.

In the summer, most people said they would be comfortable attending a remote appointment.

And most GPs feel that greater use of remote care should be retained in the longer-term...

Do remote appointments lead to different courses of action?

Prescribing of new medication is now more common in remote GP appointments.

The rate of GP referrals to consultant-led care has shifted and is now higher for remote GP appointments.

The proportion of outpatient attendances that result in a patient being discharged is lower for remote than for face-to-face appointments.

What does this mean for quality?

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More on the rise of remote care

QualityWatch indicators to keep an eye on...

GP referrals

Cancelled operations

Cancer waiting times