The potential for alternatives to face to face consultations in UK Primary Care: a realist review.

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The problem

Communications technologies are routinely used by the public in everyday life, and there is an expectation that this should extend to healthcare. This expectation is supported by policymakers, who believe that alternatives to face-to-face (F2F) consultation could have a transformative impact on general practice. Evidence to date has assessed the potential impact of some alternatives on clinical outcomes. Whilst trial evidence is poor, observational data has pointed towards some benefit. What the existing literature does not tell us is under what conditions, with which patients and in which ways alternative methods of consultation actually work. We are conducting a realist review to explore this further. Our aim is to determine what is known about the experiences of using alternatives to F2F consultations in primary care, including barriers to implementation in different settings and populations. The approach We have conducted a wide ranging literature search using the main medical databases and grey literature to identify studies that explore, or test, the effects of alternatives to F2F consultations in relation to experiences, or described theories or ideas about the potential effects. SZ and HA are in the process of examining titles and abstracts. We have devised an initial matrix which serves as our main data extraction framework. Full texts once selected will be considered in relation to their relevance and rigour. We will use constant comparison between reading and the matrix to identify the point at which no new ideas are emerging and we are confident that we have achieved saturation.


We have identified an initial 5131 records and are now examining full text articles. Our initial ‘map' or overview has identified both positive and negative effects of alternatives to F2F consultations according to different groups e.g. patient versus practice staff. Even where alternatives are in use primary care professionals share concerns based on speculation rather than their experiences, and this influences the implementation of alternatives. Patients value improved access, convenience and continuity of care. The review is ongoing and we continue to identify papers and books by snowballing from reference lists as promising ideas emerge , refining our matrix as we read more papers.


The review is part of a wider study (AltCon) which aims to understand how, under what conditions, for which patients, and in what ways, alternatives to F2F consultations such as use of the telephone, email or internet video may offer benefits to patients and practitioners in general practice. The findings of the review will guide a focused ethnography in general practice, occurring over 8 practices in 3 different areas, where GPs, patients and practice staff will be interviewed and where we will observe how practices record details of consultations not delivered F2F.


  • Helen Atherton, University of Bristol, Bristol, UK
  • Chris Salisbury, University of Exeter, Exeter, UK
  • Brian McKinstry
  • John Campbell, University of Edinburgh, Edinburgh, UK
  • Sue Ziebland, University of Bristol, Bristol, UK