Full title of project

The potential of alternatives to face to face consultation in general practice, and the impact on different patient groups.

Background and rationale

Communications technologies are routinely used by the public in everyday life, and there is an expectation that this should extend to healthcare. This expectation is supported by policymakers, who believe that alternatives to face-to-face (F2F) consultation could have a transformative impact on general practice, with advantages in terms of access and resource use.

Evidence to date has assessed the potential impact of some alternatives on clinical outcomes. Whilst trial evidence is poor, observational data has pointed towards some clinical benefit. There has also been a focus on obtaining speculative opinions from both patients and healthcare professionals on whether and how they would use these alternatives. What the existing literature does not tell us is under what conditions, with which patients and in which ways alternative methods of consultation actually work.

Aim

To understand how, under what conditions, for which patients, and in what ways, alternatives to F2F consultations such as use of the telephone, email or internet video may offer benefits to patients and practitioners in general practice.

Identifying evidence base

We will conduct a synthesis of qualitative and quantitative research on patients’ and practitioners’ experiences of alternatives to F2F consultations, with a particular focus on the views of different groups of patients and on factors that promote or hinder the wider implementation/uptake of these alternatives forms of consultation.

Developing theory

The study uses a mixed methods case study design. Using a scoping exercise we will identify the range of ways in which general practices in England and Scotland are currently providing alternatives to F2F consultations and identify approx. 8 practices with varied experience of implementing these alternatives to act as case studies employing a ‘focused ethnography’ approach.

In each case study practice we will interview clinicians and other practice staff to understand the alternatives to F2F consultations that have been tried, why and how these were introduced, key contextual factors, barriers and facilitators to implementation, and intended benefits for patients, clinicians and/or practices. We will explore assumptions about how the alternative forms of contact might lead to benefits.

We will interview patients to explore advantages/disadvantages of alternatives to F2F consultation, and how different forms of communication impact on the consultation and the clinician-patient dynamic. We will purposively select patients with different characteristics (e.g. age, deprivation, long term conditions). A key focus will be the impact of alternative forms of access on different patient groups and whether they increase or reduce access inequalities.

We will observe how practices record details of consultations not delivered F2F and, if possible, use routine data to quantify this, analysing the number of patients using these alternatives, how this has changed over time, and in particular take-up by different patient groups.

Modelling process and outcomes

Based on our findings we will develop a website resource and recommendations for general practices about the most promising applications of alternatives to F2F consultations for different patient groups, for different purposes and in different practice contexts. These recommendations will be developed by the research team and optimised and validated at a workshop involving patients, GPs and other stakeholders.

Treating provision of alternatives to F2F consultations based on our recommendations as an intervention, we will use our findings within a theory based evaluation approach to model the key contextual factors, processes and outcome measures that need to be assessed in a subsequent evaluation. This includes the extent to which the intervention can be standardised, feasibility across a range of practice settings, which alternatives to F2F consultations to offer, the number of patients who are likely to use them, for which purposes, and consultation rates.