Before introducing an alternative to a face-to-face consultation then you may wish to think about the following:

Getting it “right” is dependent on your rationale for using an alternative to a face-to-face consultation? Is it for convenience for patients, improved patient access or to manage demand? It is also dependent on ensuring that the alternative to a face-to-face consultation(s) you have decided to introduce are suitable for your practice and its demographics. Click for links to Who is it for? and For what purpose?

Successful introduction

Whatever the reason for introducing an alternative to a face-to-face consultation there is an assumption that patients would welcome the use of an alternative to a face-to-face consultation. It is worth consulting with a representative sample of your patients, maybe through a patient participation group, to understand the views of your patient population and what technology would be welcomed and which would not be. 

Patients need to be aware of the introduction of an alternative to a face-to-face consultation in order for them or the practice to benefit. You need to carefully consider how you will inform your patients. Reception staff are key to ensuring that patients are informed and that alternatives are offered to patients seeking an appointment. 

They may also require some level of patient education and preparation so think around what might be necessary and not assume that patients will fully understand what you are doing or why without this.

There may be a cost associated with promotion and information both financially and in terms of resources. These might include: letters to patients, information on your website and telephone systems, flyers and banners in the surgery and the use of social media to promote the changes but it can also rely on word of mouth from within the practice. This could be from the practitioners but also the reception staff and it is important to consider the extra work this might incur. The impact on staff is discussed further here.

Impact on patients

Introducing an alternative to a face-to-face consultation can be seen as improving convenience for patients, allowing them to communicate with their GP anytime/anywhere, reducing the time that would be taken to visit the practice and the associated cost savings. The patients we spoke to told us that, alongside the convenience, they liked an alternative to a face-to-face consultation because they felt “Empowered” (to have a choice of ways to communicate with their GP), they liked to use it for continuity of care, and for patients who are unsure what to do.

Some described that using an alternative to a face-to-face consultation made them feel more at ease. It was particularly useful for those who were shy or preferred to avoid social encounters. Some patients spoke of being able to discuss issues that they would feel uncomfortable about in a face to face consultation and therefore felt they could express themselves better. Another bonus was avoiding the waiting room - either because of the risk of catching an infection but was also challenging for those with social anxiety - and avoiding waiting on the phone or circumnavigating the receptionist.

However, patients also appreciate knowing what to expect when they use an alternative to a face-to-face consultation, for instance knowing that an email has arrived at its destination and when to expect a response. Waiting around for a telephone call or an email can be more inconvenient for them and there is a chance that they will become anxious and duplicate work by contacting the practice again. Therefore, a contingency should be in place to ensure that communication by asynchronous alternatives is responded to, and in a timely fashion, and thought should be given to how expectations of all parties would be managed.

An alternative to a face-to-face consultation is often offered to patients when there are no available face-to-face appointments. Although many patients appreciate getting at least some form of contact with a practitioner, others reported feeling “fobbed off”. Be aware that in cases where patients may be dissatisfied this may result in extra work if they contact the practice again.

There have been some concerns that the use of an alternative to a face-to-face consultation will diminish valued aspects of primary care such as the relationship and continuity of care. However, findings from our study indicated that although some aspects can be lost, such as non-verbal cues, it was still possible to maintain a relationship. Improved access through use of alternatives to face to face consultation could enhance continuity of care and as a result increase patient satisfaction. Some patients reported feeling that by their GP communicating via an alternative to a face-to-face consultation they were demonstrating a greater level of care.

Disadvantaged patients

There is an assumption that the use of alternatives to face-to-face consultations would suit particular groups of patients and disadvantage others. There is further information on this here.

Additional costs

Whilst most of the population now have access to a telephone and the internet, consider that for some patients this might be at an additional cost and their access may be limited.

Safety and security

One of the concerns about the use of an alternative to a face-to-face consultation is issues of safety and security. It is important that patient information and clinical governance are considered and that the practice follows guidelines. It is also important to remember that patients using Alt-Con may not be using secure systems to respond to you. We have provided some useful guidance below:

• NHSmail: a secure email service approved by the Department of Health for sharing patient identifiable and sensitive information
• Academy of Medical Royal Colleges – i-care: Information, Communication and Technology in the NHS
• Academy of Medical Royal Colleges – Ehealth Competency Framework
• GMC guidance on – Prescribing Guidance: Remote Prescribing via Telephone, Video-link or Online
• Email Consultations in Healthcare
• Health and Social Care Information Centre
• Medical Protection – Risk alert: Technology in general practice
• RCGP – Health Informatics Group