Date: 30 January 2018
The realities of implementing alternatives to face-to-face GP consultations, such as telephone, email, online and video consultations, mean that hoped-for reductions in GP workload and increases in available appointments for patients might not be realised, an NIHR-funded study has found.
This is the finding of research by led by researchers at the University of Bristol, published in the British Journal of General Practice today.
NHS policy encourages general practices to introduce alternatives to face-to-face consultations as a way of increasing access to healthcare and reducing GP workload. However, the evidence on their use and effectiveness is limited.
The researchers studied, in depth, how a variety of technological alternatives to GP consultations were being used in eight general practices of different sizes, in different geographical areas – some urban, some rural – and in different areas of socioeconomic deprivation in the UK. They found that although there were some potential benefits, there were also significant barriers to implementation, with practices often responding to incentives to introduce new technologies without a clear rationale or clearly thinking through the likely costs and benefits for patients and practice staff.
There was also insufficient training of non-clinical staff, such as nurses and receptionists, on how to use the technologies appropriately and communicate the benefits to patients.
Professor Chris Salisbury from the University of Bristol’s Centre for Academic Primary Care said: “Technological alternatives to face-to-face GP consultations are being pushed as the solution to reducing GP workloads and increasing patient access to primary care services. The reality on the ground is that implementation is difficult. Practices are introducing the technologies for different reasons and a ‘one size fits all’ approach will not work.
“Our study shows that, currently, GP practices are struggling to identify and implement the most beneficial uses of these new technologies and they are frequently being adopted without sufficient understanding or support.
“In particular, we identified a tension between the desire to make access to health care easier and more convenient, while at the same time aiming to reduce GP workload. We found that new ways of accessing health care advice may well increase rather than decrease GP workload."
The research was a collaboration between the Universities of Bristol, Warwick, Oxford, Edinburgh and Exeter.
Dr Helen Atherton, from the University of Warwick and lead author of the study, said: “Our findings suggest that policy-driven top-down approaches that use financial incentives as a way of encouraging adoption of alternative consultation methods is not the best way forward if efficiencies are to be made. Instead, individual practices should take a considered and tailored approach, based on the needs of their practice population, and available resource, so that there is equitable delivery of care.”
The team has also provided guidance for GPs.
More information on the study is available on the NIHR Journals Library.
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