Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study
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Abstract
Background: To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. Aim: To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. Design and setting: Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. Method: Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices’ experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory. Results: There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. Conclusion: The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
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Some asynchronous platforms had expected response times ranging from 15 minutes to 48 hours.
“Some had expected response times, ranging from 15 minutes 34,35 to 48 hours. 43”
From Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review (2024) · cites this paper as [43]
Concerns about equity included digitally excluded patients and reinforcing health inequities.
“Concerns included digitally excluded patients and reinforcing health inequities. 31–33,43,48”
From Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review (2024) · cites this paper as [43]
Most remote consultations before and during the pandemic occurred by telephone.
“most remote consultations before and during the pandemic occurred by telephone (3, 12–15).”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [14]
Staff later reported feeling tired and under pressure as well as concerned about the loss of in-person care, threats to the therapeutic relationship, potential for missed diagnoses especially in deprived and vulnerable groups, and a rising backlog of unmet need.
“they later reported feeling tired and under pressure as well as concerned about the loss of in-person care, threats to the therapeutic relationship, potential for missed diagnoses especially in deprived and vulnerable groups, and a rising backlog of unmet need”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [14]
Observational studies documented a sharp increase in remote consultations (telephone, e- and video, in that order) during the first wave in the UK.
“Observational studies documented a sharp increase in remote consultations (telephone, e- and video, in that order) during the first wave in the UK (14, 15)”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [14]
Staff experienced the pandemic shift to remote consultation as organizationally and professionally challenging but considered it justified for safety reasons.
“that staff experienced the shift as organizationally and professionally challenging but considered it justified for safety reasons”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [14]
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- Authors
- Murphy, M., Scott, L. J., Salisbury, C., Turner, A., Scott, A., Denholm, R., Lewis, R., Iyer, G., Macleod, J., & Horwood, J.
- Affiliations
- University of Bristol (GB)
- Bristol Clinical Commissioning Group (GB)
- ORCID
- Venue
- British Journal of General Practice
- Published
- 2021-01-17
- Volume
- 71
- Issue
- 704
- Pages
- e166-e177
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC7909923
- OpenAlex
- W3119657379
- Cited by
- 486
- References
- 24
- Citations by year
- 2026: 37 · 2025: 54 · 2024: 89 · 2023: 122 · 2022: 128 · 2021: 54
- FWCI
- 84.99
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of General Practice (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (acceptedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (NIHR202406, NIHR201314)
- Department of Health and Social Care
- University of Bristol
- NIHR School for Primary Care Research
- National Institute for Health Research Applied Research Collaboration West
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- COVID-19 pandemic, primary care, general practice, telephone consultation, video consultation, teleconsultation, Normalisation Process Theory, vulnerable patients, shielding, mental health, text messaging, clinical risk
- MeSH terms
- Change Management, COVID-19, SARS-CoV-2, Adult, Aged, 80 and over, Attitude of Health Personnel, Communicable Disease Control, Female, United Kingdom, Humans, Infant, Newborn, Male, Practice Patterns, Physicians', Primary Health Care, Disease Transmission, Infectious, Remote Consultation, Practice Patterns, Nurses', General Practitioners
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