Before introducing an alternative to a face-to-face consultation 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?

Ways to monitor success from a patient perspective

• Are your patients aware of the availability of alternatives to a face-to-face consultation? You could assess this through a quick survey of patients seeking to book an appointment and through discussion with your patient participation group.
• Are patients using an alternative to a face-to-face consultation? Audit the level of use of alternative consultation types through regular audits of the practice computer system. This will only be possible if different appointment types have been recorded systematically and reliably. A clear standard operating protocol is useful to make it clear who should record what.
• Does it lead to repeated consultations? Audit a sample of consultations which began as an alternative consultation type and assess how many converted to a face-to-face or repeat consultation.
• Does it lead to an impact on total workload and the number of consultations overall? This can be monitored on a monthly basis to see whether anticipated changes in consultation numbers have occurred.
• Does it affect patient satisfaction? Conduct in-house patient surveys or pay attention to the results of the national GP Patient Survey for your practice.
• Does it disadvantage certain groups or has it resulted in an increase in consultations with hard to reach groups? We have developed a 'Multimorbidity search tool for EMIS practices' which can identify patients with multimorbidity. These patients are heavy users of health care and may be benefited or disadvantaged by changes in appointment systems.
• Has it led to more or fewer non-attendance by patients (DNAs)? This can be assessed through regular audit of your computer system.

Ways to monitor success from a staff perspective

• Are all staff using an alternative to a face-to-face consultation? Audit appointment bookings and the consultation type.
• Are all staff using an alternative to a face-to-face consultation as it is designed to be used? Audit adherence to protocols.
• What is the impact of using an alternative to a face-to-face consultation on staff? Conduct staff surveys, discuss with staff and look at retention of staff and reasons for leaving.

Ways to monitor success from an organisational perspective

• Is an alternative to a face-to-face consultation being used? Audit the level of use of alternatives to a face-to-face consultation.
• Does it save time/provide more appointments? The number of consultations of each type, and the overall number of consultations can be monitored on a monthly basis through regular searches of your computer system to see whether anticipated changes in consultation numbers have occurred. To make this possible it is vital that everyone records consultation type in the same way.
• Does it affect safety or does it require improved safety netting? Audit logging of adverse incidents.
• What is the cost of using an alternative to a face-to-face consultation, both anticipated and unanticipated? Conduct a financial review, taking into account indirect costs and any savings elsewhere in the system.
• Has the use of alternatives to face-to-face consultation led to the benefits you set out to achieve? If so, have the benefits been worth the cost?
• Have there been unanticipated benefits or unintended adverse consequences? Discuss with staff.