Alternatives to face-to-face GP consultations unlikely to deliver hoped-for benefits in practice

The realities of
implementing alternatives to face-to-face GP consultations, such as telephone,
email, online and video consultations, mean that hoped-for reductions in GP
workload and increases in available appointments for patients might not be
realised. This is the finding of a study by led by researchers at the
University of Bristol, published in the British Journal of General Practice
today.

NHS policy encourages
general practices to introduce alternatives to face-to-face consultations as a
way of increasing access to healthcare and reducing GP workload. However, the
evidence on their use and effectiveness is limited.

The researchers studied, in
depth, how a variety of technological alternatives to GP consultations were
being used in eight general practices of different sizes, in different
geographical areas – some urban, some rural – and in different areas of
socioeconomic deprivation in the UK. They found that although there were some
potential benefits, there were also significant barriers to implementation,
with practices often responding to incentives to introduce new technologies
without a clear rationale or clearly thinking through the likely costs and
benefits for patients and practice staff.

There was also insufficient
training of non-clinical staff, such as nurses and receptionists, on how to use
the technologies appropriately and communicate the benefits to patients.

Professor Chris Salisbury
from the University of Bristol’s Centre for Academic Primary Care said:

“Technological alternatives
to face-to-face GP consultations are being pushed as the solution to reducing
GP workloads and increasing patient access to primary care services. The
reality on the ground is that implementation is difficult. Practices are
introducing the technologies for different reasons and a ‘one size fits all’
approach will not work.

“Our study shows that,
currently, GP practices are struggling to identify and implement the most
beneficial uses of these new technologies and they are frequently being adopted
without sufficient understanding or support. Implementation was not well enough
thought through in relation to personnel, training or logistical factors. As a
result, efficiencies are not being realised.

“In particular, we
identified a tension between the desire to make access to health care easier
and more convenient, while at the same time aiming to reduce GP workload. We
found that new ways of accessing health care advice may well increase rather
than decrease GP workload”.

Dr Helen Atherton, from the
University of Warwick and lead author of the study, said:

“For patients, the
availability of a wider range of options for consulting could be very helpful
for some patient groups but has the potential to reduce the time the doctor has
available for face-to-face consultations, which could disadvantage other
patients.

“Our findings suggest that
policy-driven top-down approaches that use financial incentives as a way of
encouraging adoption of alternative consultation methods is not the best way
forward if efficiencies are to be made. Instead, individual practices should
take a considered and tailored approach, based on the needs of their practice
population, and available resource, so that there is equitable delivery of
care.

“We have produced guidance
for GPs that will help them do this and are planning to do further evaluations
of newer technologies, such as electronic consultations and video
consultations, in the future.”

The research was a
collaboration between the Universities of Bristol, Warwick, Oxford, Edinburgh
and Exeter and was funded by the National Institute for Health Research (NIHR).

Paper

‘Alternatives to the face-to-face consultation in general practice: focused ethnographic case study’. Helen Atherton, Heather Brant, Sue Ziebland, Annemieke Bikker, John
Campbell, Andy Gibson, Brian McKinstry, Tania Porqueddu, Chris Salisbury.
Published in the British Journal of General Practice.