The DOI matches its Crossref record; 24 of the 24 references it cites were found in a registry or an index.
Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study
Open accessPublished version of a preprint
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 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]
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“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]
In the citing paper
“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]
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“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]
In the citing paper
“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]
In the citing paper
“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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Cites
Qualitative Quality: Eight “Big-Tent” Criteria for Excellent Qualitative Research
Tracy, S. J. (2010) · Qualitative Inquiry · doi:10.1177/1077800410383121 · Cited by 7,536 · cited 1×
“23 Then, all data was coded relating to remote consulting into the final framework.”
MethodGreenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8775 · Cited by 2,887
Alderwick, H., & Dixon, J. (2019) · British medical journal · doi:10.1136/bmj.l84 · Cited by 1,985
Development of a theory of implementation and integration: Normalization Process Theory
May, C. R., Mair, F., Finch, T., MacFarlane, A., Dowrick, C., Treweek, S., Rapley, T., Ballini, L., Ong, B. N., Rogers, A., et al. (2009) · Implementation Science · doi:10.1186/1748-5908-4-29 · Cited by 1,409 · cited 4×
“Normalisation Process Theory (NPT) 22 was used to structure the analysis of the implementation of remote consulting.”
MethodInfluentialVideo consultations for covid-19
Greenhalgh, T., Wherton, J., Shaw, S., & Morrison, C. (2020) · BMJ · doi:10.1136/bmj.m998 · Cited by 866
Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care
Donaghy, E., Atherton, H., Hammersley, V., McNeilly, H., Bikker, A., Robbins, L., Campbell, J., & McKinstry, B. (2019) · British Journal of General Practice · doi:10.3399/bjgp19x704141 · Cited by 537
Hammersley, V., Donaghy, E., Parker, R., McNeilly, H., Atherton, H., Bikker, A., Campbell, J., & McKinstry, B. (2019) · British Journal of General Practice · doi:10.3399/bjgp19x704573 · Cited by 366
Ignatowicz, A., Atherton, H., Bernstein, C. J., Bryce, C., Court, R. A., Sturt, J. A., & Griffiths, F. E. (2019) · Digital Health · doi:10.1177/2055207619845831 · Cited by 182
Joy, M., McGagh, D., Jones, N., Liyanage, H., Sherlock, J., Parimalanathan, V., Akinyemi, O., van Vlymen, J., Howsam, G., Marshall, M., et al. (2020) · British Journal of General Practice · doi:10.3399/bjgp20x710933 · Cited by 178
Thiyagarajan, A., Grant, C., Griffiths, F., & Atherton, H. (2020) · BJGP Open · doi:10.3399/bjgpopen20x101020 · Cited by 169
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Omboni, S., Padwal, R. S., Alessa, T., Benczúr, B., Green, B. B., Hubbard, I., Kario, K., Khan, N. A., Конради, А. О., Logan, A. G., et al. (2022) · Connected Health · doi:10.20517/ch.2021.03 · Cited by 401
Erku, D., Khatri, R. B., Endalamaw, A., Wolka, E., Nigatu, F., Zewdie, A., & Assefa, Y. A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20196854 · Cited by 200
Greenhalgh, T., Rosen, R., Shaw, S. E., Byng, R., Faulkner, S., Finlay, T., Grundy, E., Husain, L., Hughes, G., Leone, C., et al. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2021.726095 · Cited by 173
“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).”
BackgroundHPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK
Choi, S., Ismail, A., Pappas‐Gogos, G., & Boussios, S. (2023) · Pathogens · doi:10.3390/pathogens12020298 · Cited by 197
Knights, F., Carter, J., Deal, A., Crawshaw, A. F., Hayward, S. E., Jones, L., & Hargreaves, S. (2021) · British Journal of General Practice · doi:10.3399/bjgp.2021.0028 · Cited by 153
Metadata
- 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 › 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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