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February 1 2018 Alternatives to face-to-face GP consultations may not deliver as many benefits as...

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    Friday, 16 February 2018 18:16
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    Tuesday, 06 February 2018 11:39
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  • Alternative consultation methods may not deliver significant improvements in GP workload

    Alternative consultation methods may not deliver significant improvements in GP workload

    Thursday, 01 February 2018 11:14

a dr on phone imageFebruary 1 2018

Alternatives to face-to-face GP consultations may not deliver as many benefits as originally hoped, a qualitative study has suggested. Any reduction in GP workload brought about by conducting consultations via the phone, email, e-consultation systems or internet video “may be both modest and gradual.”


The study published in the British Journal of General Practice involved observation and interviews with staff and patients in eight general practices. The researchers also reviewed documentation and protocols.

Among the findings were that:

  • practices had different reasons for introducing the alternative consultation methods;
  • there were different views on which patients and conditions would be suitable;
  • co-workers were unaware about their colleagues’ practices;
  • protocols drawn up by practices were not known or followed.

However, the researchers also found that patients were reporting benefits including convenience and access, and “staff and some patients regarded the face-to-face consultation as the ideal.”

The National Institute for Health Research, which funded the study, noted: “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.

“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.”

The research was led by the University of Bristol in collaboration with the Universities of Warwick, Oxford, Edinburgh and Exeter.

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. 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.”

Professor Kamila Hawthorne, RCGP Vice Chair, said: “Innovative use of technology must continue to be explored in general practice, as long as it is safe, effective and leads to better outcomes for our patients, the GP practice and the NHS as a whole. Patient safety must be paramount in any clinical consultations.

“Many GP practices are already offering online consultations in some form, and we know that they are convenient for some patients. However, we also know – and this research backs this up – that they don’t necessarily help to alleviate workload pressures on GPs, or improve access to general practice services for patients … if practices do choose to offer them, then it should be as one way to access GP services, not the only way.”

Prof Hawthorne endorsed the researchers’ recommendation for practices to carefully consider the implications of introducing alternative consultation methods for the practice and patients. The RCGP is developing guidance on this, she said, adding: “If this route to consulting with patients is being considered by a practice, practice policies must be developed carefully, agreed by all in the practice, and followed to ensure patient safety.”

Links:
H Atherton et al. Alternatives to the face-to-face consultation in general practice: focused ethnographic case study. Br J Gen Pract 29 January 2018; bjgp18X694853.           
NIHR statement            
RCGP statement           

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