Independent think tank, the Nuffield Trust, has warned that while remote GP consultations may be convenient for patients and doctors, they run the risk of vital diagnoses being missed and could result in higher GP workload and worsening health inequalities.
According to the think tank’s new report, entitled Getting the best out of remote consulting in general practice, GP practices need to become better at offering alternative appointment types to patients who struggle to access with digital services, and for clinical conditions where remote consulting is simply impractical.
The study finds that remote consultations provide a convenient way for many patients to access healthcare without requiring time off work or away from other commitments. Among their positive aspects, remote appointments enable doctors to see patients in an efficient and timely way and can work well in diagnosing common conditions such as skin rashes, simple chest infections, and disease monitoring for other conditions such as asthma and high blood pressure.
On the flip-side, the report’s authors uncovered that remote consultations can sometimes take longer than in-person appointments and can reduce access to care for some patients and vulnerable groups. This, they say, could make health inequalities worse.
Furthermore, the report outlines that remote consultations come with their own degree of clinical risk. Some GPs themselves expressed concerns over missed or delayed diagnoses caused by loss of information from visual clues and physical examination; missed signs of safeguarding risk; lost opportunities for public health interventions; and increased use of investigations and referrals to other services.
The research finds that reception staff became the frontline for assessing whether patients are suitable for remote consulting and were often at the forefront of patients’ frustrations with the offer of a remote consultation if their needs or preferences were not met.
The report goes on to recommend that practices routinely check in with patients if they are able to participate in a remote consultation at the time that they request an appointment, and adapt the appointment offered in response to each individual patient's needs.
The authors also argue that, where capacity is limited, reception staff require the skills to communicate why they can’t offer what the patient needs – or what is preferred by patients who don't have specific needs – and negotiate alternative options with them. This will require a change in training for receptionists, with potential to lean from the Netherlands where they provide a three-year training programme for a broad role as ‘clinic assistants.’
Responding to the report, Lewisham-based GP and senior clinical fellow at the Nuffield Trust, Rebecca Rosen, said: “Covid-19 brought about a huge shift in the ways patients could see their GP, with telephone and online consultations the norm for many. This enormous change came with some challenges that must be addressed – not least the concern that medical problems may be missed, and patients may not get access to the care they need.
“Despite this, there are enough benefits to remote consultations that they are valuable when used for the right patients and clinical problems and undoubtedly here to stay. The right approach for policy makers and GP practices now is to use them selectively and not assume they are the quick fix to all the problems in getting a GP appointment.
“Training – for patients, clinicians, receptionists and GP trainees – must form a central part of an intelligent approach to their continued use in general practice, alongside support for continuity of care and the vitally important face-to-face appointment.”
Photo by National Cancer Institute on Unsplash
