Cited by 486Telemedicine and Telehealth ImplementationHealthcare Systems and ChallengesPrimary Care and Health Outcomes

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Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study

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Murphy, Mairead, Scott, Lauren J, Salisbury, Chris, Turner, Andrew, Scott, Anne, Denholm, Rachel, Lewis, Rhys, Iyer, Geeta, Macleod, John, Horwood, Jeremy·2021·British Journal of General Practice

DOI 10.3399/bjgp.2020.0948PMC PMC7909923

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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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Qualitative Quality: Eight “Big-Tent” Criteria for Excellent Qualitative Research
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“23 Then, all data was coded relating to remote consulting into the final framework.”
Method
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MethodInfluential
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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: Murphy, Mairead
Scott, Lauren J
Salisbury, Chris
Turner, Andrew
Denholm, Rachel
Macleod, John
Horwood, Jeremy
Venue: British Journal of General Practice
Publisher: Royal College of General Practitioners
Published: 2021-01-17
Volume: 71
Issue: 704
Pages: e166-e177
ISSN: 0960-1643 (ISSN-L)
1478-5242
DOI: 10.3399/bjgp.2020.0948
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: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
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 › Medicine › Family Practice › 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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Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study

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