Abstract
Fewer than 1% of UK general practice consultations occur by video. To explain why video consultations are not more widely used in general practice. Analysis of a sub-sample of data from three mixed-method case studies of remote consultation services in various UK settings from 2019-2021. The dataset included interviews and focus groups with 121 participants from primary care (33 patients, 55 GPs, 11 other clinicians, nine managers, four support staff, four national policymakers, five technology industry). Data were transcribed, coded thematically, and then analysed using the Planning and Evaluating Remote Consultation Services (PERCS) framework. With few exceptions, video consultations were either never adopted or soon abandoned in general practice despite a strong policy push, short-term removal of regulatory and financial barriers, and advances in functionality, dependability, and usability of video technologies (though some products remained 'fiddly' and unreliable). The relative advantage of video was perceived as minimal for most of the caseload of general practice, since many presenting problems could be sorted adequately and safely by telephone and in-person assessment was considered necessary for the remainder. Some patients found video appointments convenient, appropriate, and reassuring but others found a therapeutic presence was only achieved in person. Video sometimes added value for out-of-hours and nursing home consultations and statutory functions (for example, death certification). Efforts to introduce video consultations in general practice should focus on situations where this modality has a clear relative advantage (for example, strong patient or clinician preference, remote localities, out-of-hours services, nursing homes).
Highlights
There was initial optimism that the pandemic would serve as a ‘burning platform’ to propel the UK National Health Service (NHS) towards widespread adoption of video consultations (1)
The relative advantage of video u was perceived as minimal for most of the case load of general practice, since many an presenting problems could be sorted adequately and safely by telephone and in-person M assessment was considered necessary for the remainder
Efforts to introduce video consultations in general practice should focus on situations where this modality has a clear relative advantage
Summary
This is an ‘author accepted manuscript’: a manuscript that has been accepted for publication in British Journal of General Practice, but which has not yet undergone subediting, typesetting, or correction. Errors discovered and corrected during this process may materially alter the content of this manuscript, and the latest published version (the Version of Record) should be used in preference to any preceding versions. Trisha Greenhalgh FRCGP, Professor [1] Emma Ladds MRCGP, NIHR In-Practice Fellow [1] Sietse Wieringa PhD, GP Academic [2] Gemma Hughes DPhil, Health Services Researcher [1]. 58 Lucy Moore PhD, Health Services Researcher [1] .06. Chrysanthi Papoutsi PhD, Senior Researcher [1] 1 Rebecca Rosen MRCGP, Senior Policy Analyst [3] 02 Alexander Rushforth PhD, Researcher [4] .2. Sarah Rybczynska-Bunt PhD, Postdoctoral Researcher [5] JGP Joseph Wherton PhD, Health Services Researcher [1].
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