Public perceptions and experiences of GP remote consultations during the pandemic: longitudinal qualitative findings from the COVID-19 Cancer Attitudes and Behaviours Study

Problem

The COVID-19 pandemic caused a rapid shift from face-to-face to remote general practice (GP) consultations in the UK. With restrictions on face-to-face primary care services enforced from March 2020 to reduce contagion, remote consultations provided a means of supporting patients and maintaining crucial services. Understanding the acceptability and potential impact of this restructuring on symptom help-seeking behaviours in the general population is essential to inform future service planning in primary care, especially considering the GP gateway for urgent referrals for suspected cancer. We explored the changing views and experiences of remote GP consulting from the public perspective at two time points during the pandemic.

Approach

Adult participants in the COVID-19 Cancer Attitudes and Behaviours Study cohort who consented to interview were purposefully sampled (by age, gender and symptom experience) for semi-structured paired telephone interviews. Interviews were conducted between September and November 2020 (Wave1) and March and April 2021 (Wave 2). Participants were asked about their views and experiences of GP remote consultations as part of a wider interview. Consent for interview and audio-recording was reconfirmed verbally prior to commencement, and participants were reimbursed with a £20 voucher. Audio recordings were transcribed, anonymised and thematically analysed using inductive and deductive coding. NVivo 12 was used to aid data organisation. Twenty percent of data were independently dual coded.

Findings

Thirty participants were interviewed during Wave 1, of whom 26 were followed-up in Wave 2 (n=17 males, age 26-76 years). In Wave 1, participants who had contacted their GP during the pandemic were pleased with the care received and use of remote procedures (majority telephone based). Initially the prospect of remote procedures had put participants off and acted as a barrier to help-seeking, though when experienced these were better than anticipated. Participants were amenable to continued use of remote consulting in the knowledge that face-to-face appointments would be available based on clinical need and preference, and that the needs of those potentially excluded from remote consulting were being considered. Initially, participants described understanding the need to protect the NHS and reduce GP contact. At follow-up, they had assumed that the increased flexibility and efficiency afforded by remote consultations would translate into additional capacity and were very discouraged at finding it harder to get GP appointments again for themselves and others. This was also heightened by an awareness of negative media reporting on the topic.

Consequences

Remote consultations were broadly acceptable to the public, especially for non-urgent concerns, but enthusiasm waned as the pandemic progressed. Remote consultations are an important strategy for increasing access to primary care services, but considerations must be given to inclusivity and workforce capacity.