Bunn et al, in their systematic review published in this issue of the Journal,1 review the evidence underpinning the role of telephone consultations in triaging access to health care.1 Remote consulting, however, has the potential to impact far more broadly on clinical practice than simply facilitating triage, and, in so doing, raises important issues around the political imperatives of access and choice. In this editorial, we consider these issues and discuss a number of practical points that need to be resolved.
The telephone is increasingly used to access advice from both general and disease-specific helplines (for example, NHS Direct, Terrence Higgins Trust and Asthma UK) and there is also growing interest in telephone consultations as an alternative to traditional face-to-face reviews of people with long-term diseases.2,3 ‘Texting’ may encourage teenagers and young adults, to use the health service.4 Although use of e-mail consultations is currently limited, the majority of people with internet access (now approximately 60% of the UK population) express interest in using it to communicate with their healthcare provider.5–7 Plans for electronic patient records, linked with the patient's personal internet account (available to UK residents at www.healthspace.nhs.uk) will offer further innovative possibilities for interacting with healthcare professionals.
In parallel with the imperative to improve access, policy rhetoric implies that alternative modes of consultation will offer patients choice about when, with whom, and how they consult. …