Remote GP consultations here to stay but are not a fix for all ills, think tank warns

‘Remote’ consultations with a GP – using telephone, online services or video – can be convenient for patients and work well for monitoring certain diseases, but they can risk missing vital diagnoses, worsen health inequalities and increase GP workload. 

According to Getting the best out of remote consulting in general practice, a new Nuffield Trust report, practices need to become better at offering alternative appointment types to patients who struggle to access with digital services, and for clinical conditions where remote consulting just won’t work.

The study finds that remote consultations provide a convenient way for many patients to access health care without requiring time off work or away from other commitments. They can sometimes enable staff to see patients in an efficient and timely manner and are ideal for some conditions like skin rashes and simple chest infections and disease monitoring for common conditions such as asthma and high blood pressure.

Yet the authors found that they can take longer than in-person consultations and can reduce access to care for some patients and vulnerable groups, raising concerns over entrenching health inequalities. The clinical risk associated with some remote consultations was also a concern: GPs expressed worry over missed or delayed diagnoses caused by loss of information from visual clues and physical examination; missed signs of safeguarding risk; lost opportunities for public health interventions; and increased use of investigations and referrals to other services.

The research finds that reception staff became the front line for assessing whether patients are suitable for remote consulting and were often at the forefront of patients’ frustrations with the offer of a remote consultation if their needs or preferences were not met. The report recommends that practices must routinely check with patients if they are able to participate in a remote consultation at the time they request an appointment and adapt the appointment offered in response to each patient's needs.

The authors also argue that, where capacity is limited, reception staff need skills to communicate why they can’t offer what's needed – or what's preferred by patients who don't have specific needs – and negotiate alternative options. This will require a change in training for receptionists, with potential to lean from the Netherlands where they provide a three-year training programme for a broad role as 'clinic assistants'.

Commenting on the report, Rebecca Rosen, Senior Clinical Fellow at the Nuffield Trust, and a GP in Lewisham said:

“Covid-19 brought about a huge shift in the ways patients could see their GP, with telephone and online consultations the norm for many. This enormous change came with some challenges that must be addressed – not least the concern that medical problems may be missed, and patients may not get access to the care they need.

“Despite this, there are enough benefits to remote consultations that they are valuable when used for the right patients and clinical problems and undoubtedly here to stay. The right approach for policy makers and GP practices now is to use them selectively and not assume they are the quick fix to all the problems in getting a GP appointment. Training – for patients, clinicians, receptionists and GP trainees – must form a central part of an intelligent approach to their continued use in general practice, alongside support for continuity of care and the vitally important face-to-face appointment.”