What is the Impact of remote consultations on workload, work practices and staff wellbeing? A primary care qualitative interview study (RECON Study)

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

2A.6

Presenter:

Jeremy Horwood

Twitter:

@JPHorwood

Co-authors:

Anne Scott, Christalla Pithara-McKeown, Chris Salisbury, Paula Smith, Frankie Brown, John Macleod

Author institutions:

Centre for Academic Primary Care (CAPC), Bristol Medical School, University of Bristol, National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), Department of Psychology, University of Bath

Problem

Primary care is facing unprecedented levels of demand exacerbated by issues with workforce recruitment and retention and issues of ‘burnout’ are widely reported. Since the start of the COVID-19 pandemic remote consultations have become a key part of primary healthcare delivery. This study aimed investigated the impact of remote consultations on working practices, health care service delivery and staff wellbeing.

Approach

Semi-structured interviews with 22 primary care clinicians in 14 practices in the Southwest of England, between February and May 2022. Thematic analysis was used to analyse the data using NVivo 11 software for data management.

Findings

Three main themes are reported: ‘Managing workload’, ‘Decision-making and risk’ and ‘The impact of changing working practices on staff wellbeing’. 1) ‘Managing workload’ There was considerable variation between and within practices in the way that patient appointments were managed. This included initial triage, navigation systems, clinician preferences, patient preferences and choices, and the balance between face-to-face and remote consultations. There was variation in capacity to improve systems and in the employment of additional healthcare professionals to support GPs. 2) ‘Decision-making and risk’ Variation in thresholds for face-to-face consultations and tolerance of risk were factors that had an impact on some staff.3) ‘The impact of changing working practices on staff well-being’ Some clinicians valued the flexibility, increased autonomy, and the variety associated with remote consultations. However, some aspects of remote consultations were viewed as inefficient, exacerbated workload and were potentially implicated in retention issues.We found variation in the reported delivery of remote consultations with a diversity of opinion and experiences expressed from primary care clinicians. The reported increase in workload was a challenge for all practices and could be exacerbated by inefficiencies in remote consultations. The impact of remote consultations was intertwined with the pressures of workload and led to staff ‘burnout’ for some staff particularly early career GPs. Early career GPs found remote decision-making an additional challenge compared with face-to-face consultation. Repeat consultations exacerbated workload issues which had a particular impact on less experienced staff.

Consequences

Some aspects of remote consultations delivery are inefficient and coupled with the intensity of workload can have adverse effects on clinicians. Better systems, as well as the provision of support and training around decision-making would mitigate some of these adverse effects. Acknowledging the importance of staff wellbeing and finding ways to lessen the adverse effects of high intensity workloads may have an impact on job retention. For example, providing additional support for early career GPs may mitigate some of the adverse impacts on workforce retention. Involving staff in system improvements and the importance of sharing best practice was a key theme running through the findings.

Submitted by:

Jeremy Horwood

Funding acknowledgement:

This research is funded by NHS England’s NHS Insights Prioritisation Programme (NIPP) and supported by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) and West of England Academic Health Science Network (WEASN). The views expressed in this article are those of the author(s) and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.