Alternatives to the face-to-face consultation in general practice: focused ethnographic case study
Open accessAbstract
Background: NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. Aim: To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Design and setting: Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Method: Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the ‘one sheet of paper’ mind-map method to identify the line of argument in each thematic report. Results: Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other’s practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Conclusion: Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.
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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 [13]
Levels of remote consulting outside the research setting were very low pre-pandemic.
“Levels of remote consulting outside the research setting were very low pre-pandemic (12, 13, 119)”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [13]
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- [37]Salisbury C Atherton H Brant H Alternatives to face-to-face consultations in primary care 2016 http://www.bristol.ac.uk/primaryhealthcare/researchthemes/alt-con/resources/ (accessed 18 Jan 2018) PMC4917048 27215571
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- Authors
- Atherton, H., Brant, H., Ziebland, S., Bikker, A., Campbell, J., Gibson, A., McKinstry, B., Porqueddu, T., & Salisbury, C.
- Affiliations
- University of Warwick (GB)
- University of Bristol (GB)
- University of Edinburgh (GB)
- University of Exeter (GB)
- University of the West of England (GB)
- University of Oxford (GB)
- ORCID
- Venue
- British Journal of General Practice
- Published
- 2018-01-29
- Volume
- 68
- Issue
- 669
- Pages
- e293-e300
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC5863684
- OpenAlex
- W2778645981
- Cited by
- 107
- References
- 26
- Citations by year
- 2026: 3 · 2025: 14 · 2024: 11 · 2023: 13 · 2022: 21 · 2021: 16 · 2020: 12 · 2019: 13 · 2018: 4
- FWCI
- 10.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- British Journal of General Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, other-oa)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- UWE Research Repository (UWE Bristol) (submittedVersion, cc-by)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Figshare (submittedVersion)
- Explore Bristol Research (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (13/59/08, HS&DR/13/59/08, NF-SI-0515-10043, NF-SI-0512-10128)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- telephone consultation, e-consultation, general practice, patient access, staff workload, NHS policy
- MeSH terms
- Adult, Anthropology, Cultural, Attitude of Health Personnel, Female, United Kingdom, Humans, Male, Physician-Patient Relations, Workload, Patient Satisfaction, Remote Consultation, Health Care Surveys, Practice Management, General Practice
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