The potential for alternatives to face to face consultations in UK Primary Care: thematic analysis of free text responses to a scoping survey.

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 but what the existing literature does not tell us is under what conditions, with which patients, and in which ways alternative methods of consultation such as use of the telephone, email or internet video actually work and how they may offer benefits to patients and practitioners in general practice. As part of a wider project which aims to understand this we have conducted a scoping survey of general practices to establish the current use of alternatives to face to face (F2F) GP consultations. The approach We sampled general practices in our three study areas; Bristol, South Gloucestershire and North Somerset, Oxford, and Lothian, Highlands and Western Isles. This was a total of 421 practices, and we sent a survey to every GP and the practice manager in each practice (2719 surveys). The survey ascertained whether individual GPs and practices have used, are currently using or are considering using an alternative to F2F consultations. The recipients were encouraged to highlight any interesting or unusual ways in which they use these different approaches and if plans to use alternatives had changed, why, in a free text box. We are conducting a thematic analysis of these comments with an emphasis on the perceived risks and benefits of the use of alternatives.

Findings

To date we have received 772 replies from 289 practices. 215 respondents provided a free text comment representing 146 practices. 17 of the respondents were aged between 25-34 years, 47 between 35-44, 108 between 45-54 and 42 were over 55 years of age. Emerging themes from the free text comments will be presented as risks and benefits for the GP, other practice staff, patients in general and as sub-groups These include the potential benefits for frail elderly and others who experience difficulties with access, while concerns, which were often speculative, include that patients might use email ‘inappropriately' and be more demanding with implications for time management, confidentiality, safety and medico -legal concerns.

Consequences

The findings of this survey will guide us in recruiting general practices to a focused ethnography, which will be an in-depth exploration of practices experience of implementing alternatives to face to face consultation using a case-study approach. It will 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.

Credits

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