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Saturday 18 August 2018
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Face-to-face consultation alternatives may not ease workload or improve patient access, study finds

A study in the BJGP found technological alternatives to GP consultations might not improve patient access and reduce workload

Alternatives to face-to-face GP consultations are difficult to implement and might not translate into better patient access and reductions in workload, new research has suggested

Practices were struggling to implement alternatives to traditional consultations, a study published today (30 January) in the British Journal of General Practice has found.

The researchers from the Universities of Bristol, Warwick, Oxford, Edinburgh and Exeter found that despite the NHS encouraging practices to seek for these alternatives, a lack of clear guidance and a ‘one size fits all’ approach are making the implementation of these alternatives difficult.

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study consisted of 45 interviews with staff members from different practices in urban and rural areas, which were already offering alternatives to face-to-face consultations including e-mail, video and telephone consultations.

Practices had different reasons for providing alternatives to face-to-face consultations, such as the need to offer care to patients in remote locations or those who could not attend appointments in person, to provide time-poor patients with a solution, improve efficiency and release pressure from reception staff.

'Implementation is difficult'

Co-author of the study professor, Chris Salisbury from the University of Bristol’s centre for academic primary care, said:  ‘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.’

Sufficient understanding of these alternatives and support should be available for practices to successfully implement these changes and enjoy the benefits, said Professor Salisbury.

He said: ‘Implementation was not well enough thought through in relation to personnel, training or logistical factors. As a result, efficiencies are not being realised.’

One of the practices researchers spoke with examined whether telephone consultations would save time and was surprised that it was not the case.

According to the study, the practice manager said: ‘We’d thought that we might be able to do two things, do two telephone consultations in the time it took to do a face-to-face…and that hasn’t proved to be the case.’

The need for a clear guidance

Lead author of the study Dr Helen Atherton, from the University of Warwick believes that a tailored approach based on the need of individual practices should be the way forward to implementing alternatives to face-to-face appointments.

She said: ‘Individual practices should take a considered and tailored approach, based on the needs of their practice population and available resource so that there is equitable delivery of care.

‘We have produced guidance for GPs that will help them do this and are planning to do further evaluations of newer technologies, such as electronic consultations and video consultations, in the future.’

The RCGP said that the study suggests that ‘careful consideration is needed when finding alternatives to the traditional face-to-face appointments.

Vice chair of the Royal College of GPs professor Kamila Hawthorne said: ‘We agree with the researchers that any practices thinking about alternatives to face-to-face consultations should do so after careful consideration of the implications for the practice and patients, and to this end the College is developing guidance on this.

‘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.’