There have been numerous efforts to support and incentivise the use of digital technology for remote consulting in general practice, yet the Covid-19 pandemic triggered this shift almost overnight. While many patients and clinicians have welcomed the convenience, quality and safety of remote consulting, a variety of challenges have also been identified.
As the pandemic subsides and concerns shift from designing services for infection prevention to restoring high-quality care, the challenge is how to use remote consultations in ways that meet the needs of both patients and staff, while maintaining realistic assumptions about the role of technology in supporting high-quality service delivery.
In this report we set out a new framework for planning and evaluating remote consultations, and provide recommendations for policy makers, service planners and frontline staff on how to get the best out of remote consulting in the future.
The report draws on analysis undertaken as part of the UK Research and Innovation (UKRI)-funded Remote by Default (RBD) study between May 2020 and September 2021. The study involved focus groups, case studies and a Delphi consensus exercise about the ethical principles that should shape decisions about remote versus face-to-face consulting. Research findings were tested and refined during four virtual workshops with more than 100 national and local policy makers, academics, clinicians, patients and other stakeholders.
- Remote consultations offer benefits for certain types of patients and for staff. For some patients, they provide a convenient way to access health care without requiring significant time off work or away from other commitments. For staff, they can be highly effective in enabling them to see patients in an efficient and timely manner and are ideal for some conditions and aspects of disease monitoring.
- But remote consultations can also be problematic. They can take longer than in-person consultations and can reduce access to care for some patients and vulnerable groups, raising significant questions over inequality of access.
- Remote consultations also carry some risks: missed or delayed diagnoses due to loss of information from visual clues, physical examination and ‘door knob’ concerns; missed signs of safeguarding risk; lost opportunities for public health interventions; and increased use of investigations and referrals to other services. The clinical risk from remote consultations is not yet well understood.
- Some GP practices managed the switch to remote consultations better than others. The level of success related to the size of the practice, the population need, and the digital skills of the staff involved.
- Where triage works well, it steers people to the right professional and appointment type for their need and can avoid the need for a full consultation. But too often, triage arrangements are confusing and difficult for patients, and inefficient for practices, with many duplicated appointments.
- Managing the new mix of remote and face-to-face appointments can be stressful for reception staff, particularly when available appointments and triage rules conflict with patients’ expectations and preferred type of appointment.
- Many patients still value personal elements of face-to-face care in relation to both relational continuity and confidentiality (for those without access to private space) and want the freedom to choose their appointment type. Others prefer in-person consultations because they are unable to use digital services. But this can clash with capacity constraints, causing tension between patients and practice staff.
- Many clinicians report finding it harder to build relationships, trust and a holistic understanding of patients through remote encounters, which are seen as more transactional than face-to-face care.
Rosen R and Leone C (2022) Getting the best out of remote consulting in general practice – practical challenges and policy opportunities. Research report, Nuffield Trust