Before introducing an alternative to a face-to-face consultation, you may wish to think about the following patient characteristics

Age and social class

There is a perception that an alternative to a face-to-face consultation is more suitable for younger patients who are greater users of technology.

According to the office of national statistics (ONS) 99.2% of those aged between 16-24 years of age were internet users compared to 38.7% of those over 75 in 2016 which has doubled since 2011.

However, this was not borne out from our study data. Interventions introduced with younger patients in mind, such as Skype, had less uptake than expected and older patients were often keen to use email.

Assumptions about who has access to the internet favoured those in higher social classes, and there was also an assumption that professional people were more 'busy'.

However, many of those from deprived areas depend on smart phones and were familiar with the technology. One major difference is that those from lower incomes often were unable to afford large data packages.

'Able' patients

There was also a belief that some patients were more 'able' than others to use an alternative to a face-to-face consultation although there was little evidence to support that this made a difference.

These assumptions include: patients require a level of familiarity, competence and confidence (both in technology and their own health) and an alternative to a face-to-face consultation is only for 'savvy' patients - those with access to, and ability to use technology.

Finally, there was a feeling that an alternative to a face-to-face consultation should only be used with 'sensible' and 'known' patients - those who clinicians felt could be relied upon to give a fluent account of themselves without being seen face-to-face and would know when it was appropriate to communicate via alt-con and not abuse the system.

However, the findings from our study did not find any evidence to suggest that this is a reliable assumption to make.

Patients not born in the UK and for whom English is not their first language

An alternative to a face-to-face consultation is perceived to be challenging for patients not born in the UK and for whom English is not their first language mainly due to difficulties with communication and cultural differences.

A telephone consultation can be particularly challenging, however, as the GPs became familiar with their patients, telephone consultations became easier for some.

There was also the opportunity to use a translator, just the same as if the consultation was face to face, however, this also had its challenges.

Patients’ medical condition

Patient’s clinical situation may influence the use of an alternative to a face-to-face consultation. This can be a more direct way to communicate with the GP for vulnerable patients and their carers.

These might include: patients who are terminally ill - both for additional support and access to their GP, for housebound patients and those with mental health or communication issues.

Also consider that patients’ clinical condition may affect their ability to use an alternative to a face-to-face consultation either temporarily or permanently.

Not for…

There are situations that were agreed as unsuitable for an alternative to a face-to-face consultation including; consultations about children, with patients with difficult personalities or with alcohol or substance abuse, for diagnosis of new problems. See How do we get it right and How will we know it has worked.