Remote services in general practice: who needs to be trained in what, when and how?

This study aimed to identify core competencies, training needs and learning methods for general practice staff providing remote services and consultations.

Journal article

Published: 29/12/2023

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This study, carried out by Professor Trisha Greenhalgh and her team from the Nuffield Department of Primary Care Health Sciences University of Oxford, along with researchers from University of Plymouth and Nuffield Trust, concludes that a new approach and set of training competencies is needed to train all the clinical and non-clinical members of practice teams to better provide care for patients through a mix of telephone, face to face and online consultations.

Competencies framework

The research team have also developed a set of competencies for all staff groups in general practice. Practices and education providers can use these to help ensure that all staff are adequately trained in providing care by phone and other remote technologies. 

Download the competencies document


Journal article information

  • Journal of publication: British Journal of General Practice
  • Nuffield Trust contributors: Nina Hemmings and Dr Rebecca Rosen
  • All authors: T Greenhalgh, RE Payne, N Hemmings, H Leach, I Hanson, A Khan, L Miller, E Ladds, A Clarke, SE Shaw, F Dakin, S Wieringa, S Rybczynska-Bunt, SD Faulkner, R Byng, A Kalin, L Moore, J Wherton, L Husain and R Rosen
  • Volume: 2023
  • Issue: 0251



Contemporary general practice includes many kinds of remote encounter. 


To identify core competencies, training needs and learning methods for staff providing remote encounters. 

Design and setting

Mixed-method study in UK general practice. 


We collated data from longitudinal ethnographic case studies of 11 general practices; a multi-stakeholder workshop; interviews with policymakers, training providers and trainees; published research; and grey literature (e.g. training materials, surveys). Data were coded thematically and analysed using theories of individual and team learning. 


Learning to provide remote services occurred in the context of high workload, understaffing and complex workflows. Low confidence and perceived unmet training needs were common. Training priorities for novice clinicians included basic technological skills, triage, ethics (e.g. privacy, consent), and communication and clinical skills. Established clinicians’ training priorities include advanced communication skills (e.g. maintaining rapport and attentiveness), working within the limits of technologies, making complex judgements, coordinating multi-professional care in a distributed environment, and training others. Much existing training is didactic and technology-focused. Whilst basic knowledge was often gained using such methods, the ability and confidence to make complex judgements were usually acquired through experience, informal discussions and on-the-job methods such as shadowing. Whole-team training was valued but rarely available. We offer an outline set of competencies based on our findings. 


The knowledge needed to deliver high-quality remote encounters to diverse patient groups is complex, collective and organisationally-embedded. The vital role of non-didactic training eg: joint clinical sessions, case-based discussions and in-person, whole-team, on-the-job training needs to be recognised.

Read the full journal article