Practitioners and patient experience of implementation of alternatives to face to face consultations in general practice.

Problem

The ubiquitous use of new communication technologies has led to an expectation that this use should extend to healthcare. Policymakers believe that alternatives to face-to-face consultation could improve access and resource use. Research looking at the impact of alternatives suggests some clinical benefit. These studies however, do not explore the potential role that various types of consultation method can have on different types of problem and patient in diverse general practice settings. The aim of this research is to understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations such as use of the telephone, email or Internet video may offer benefits and challenges to patients and practitioners in general practice.

Approach

We are conducting focused ethnographic case studies in 8 general practices in England and Scotland. Practices are using different types of alternatives to face-to-face consultations. In each case study practice we are conducting non-participant observation and carrying out semi-structured interviews with clinicians, practice staff and patients. Interviews are digitally recorded and fully transcribed by a professional transcription service. Data collected during observation is written in form of field notes. Thematic codes for data analysis have been selected and NVivo is currently being used to gather related sections of the transcripts and field notes under thematic codes. Data are compared and analysed through charting and the OSOP mind-map method to identify the line of argument in each report, as well as outliers or negative cases.

Findings

We have completed case studies in five general practices. Included practices offered varying combinations of telephone consultations, e-consultations via software applications (e.g. WebGP), email consultations and video consultations. Despite practice enthusiasm, e-consultation software uptake by patients is low. Email consultation is rarely an integrated method of consultation instead being favoured by ‘lone wolf’ GPs using it for specific purposes with selected patients. Observations suggest that patients are not routinely offered the option of consulting online. Use of alternatives varied by clinical role with nurses using it for specific issues, e.g. insulin reviews. Professionals have differing beliefs about which patients are suitable for an alternative consultation method. Neither the anticipated efficiency benefits, nor concerns about inundation and inappropriate use have been realised in the practices studied to date. Analysis is ongoing and full findings will be available in July.

Consequences

Observations on how patients are being selected for alternative methods of consultation raises questions around their intended purpose. Information on specific uses for alternatives is potentially directly transferable across general practice settings, with the potential for alternatives varying according to the medium. We will disseminate our findings as an online toolkit with recommendations for general practices about the most promising applications of alternatives to face to face consultations.