Using alternatives to face-to-face consultations: a survey of prevalence and attitudes in general practice

Heather Brant; Helen Atherton; Sue Ziebland; Brian McKinstry; John L Campbell; Chris Salisbury

doi:10.3399/bjgp16X685597

Abstract

Background The ubiquitous use of communication technologies has led to an expectation that a similar approach should extend to health care. Despite considerable rhetoric about the need for general practices to offer alternatives to face-to-face consultations, such as telephone, email, and internet video consultations, the extent to which such technologies are actually used at present is unclear.

Aim The aim of the survey was to identify the frequency and range of ways in which general practices are providing (or planning) alternatives to face-to-face consultations.

Design and setting A postal survey of practices around Bristol, Oxford, Lothian, the Highlands, and the Western Isles of Scotland.

Method A postal questionnaire survey was sent to each of the GPs and practice managers of 421 practices between January and May 2015.

Results A response was received from 319/421 practices (76%). Although the majority of the practices reported that they were conducting telephone consultations frequently (n = 211/318, 66%), fewer were implementing email consultations (n = 18/318, 6%), and most (n = 169/318, 53%) had no plans to introduce this. None were currently using internet video, and 86% (n = 273/318) had no plans to introduce internet video consultations. These findings were repeated in the reported use of alternatives to face-to-face consultations at an individual GP level. Optional free text responses were completed by 28% of responders, and offered an explanation for the (often perceived) barriers and incentives for implementation.

Conclusion Despite policy pressure to introduce consultations by email and internet video, there is a general reluctance among GPs to implement alternatives to face-to-face consultations. This identifies a substantial gap between rhetoric and reality in terms of the likelihood of certain alternatives (email, video) changing practice in the near future.

INTRODUCTION

The need to address the issue of increasing demands on primary care, and to serve populations in remote areas, has prompted the consideration of alternative methods to provide consultations, such as email or internet video (for example, Skype^™) in Europe, the US, and Australia.¹^–⁴ General practice in the UK is under increasing pressure to improve access to patients to address the rise of patient demand within a limited capacity. Several initiatives utilising information and communications technologies have been introduced with a view to reducing GP workload; for example, telephone triage.⁵ A recent document outlining government proposals⁶ suggested that the introduction of alternative methods to provide consultations, such as email or internet video (for example, Skype^™), could improve the current provision of primary care in the UK. The Prime Minister’s Challenge Fund (PMCF) has provided financial incentives to implement such technologies in England.⁷ The underlying assumptions that drive this rhetoric relate to convenience and accessibility for patients, and an efficient use of practitioners’ time.⁸^,⁹

Despite this rhetoric about how such an approach may improve access and efficiency there is little evidence to support the claims. Evidence to date has assessed the potential impact of some alternatives on clinical outcomes.¹⁰^,¹¹ Although trial evidence is poor, observational data has pointed towards some clinical benefit, such as improved outcomes for those with diabetes and hypertension,¹² and better monitoring of health concerns,¹³ at least in market driven health systems. Studies have sought opinions from patients and healthcare professionals on whether and how they would use these alternatives¹⁴^,¹⁵ but these data have been based on hypothetical opinions rather than experience. Although professional bodies are making tentative steps towards embracing some of the newer technologies¹⁶^–¹⁸ practitioners are generally more sceptical,¹⁹^–²² reflecting uncertainty arising from a lack of evidence in the general practice setting and wider concerns about general practice workload.

The aim of this survey was to identify the frequency and range of ways in which general practice teams in five areas of the UK were providing alternatives to face-to-face consultations, or had plans to do so in the future. This information was used to identify potential practices for a focused ethnographic study which is currently underway.

METHOD

A postal survey was sent to all practice managers, GP partners, and salaried GPs (n = 2719) at all the practices in and around Bristol, Oxford, Lothian, and the Highlands and Islands of Scotland (n = 421). These areas were selected to represent diversity in terms of practice demographics: from urban to rural, inner city to remote, and from affluent to deprived locations, including practices in England that benefited from the PMCF funding. Replies within 3 weeks of receipt were entered into a draw to win an iPad Air^®.

How this fits in

Introducing alternatives to face-to-face consultations in primary care has been proposed as a solution to the increased demands faced in general practice. Politicians, and patients when asked, tend to be keen, but professional bodies and practitioners are sceptical. This study highlights that although the majority of practices offer telephone consultations on a frequent basis, most use email for direct patient care very infrequently, and very few use internet video for consultations with patients. In addition, the majority do not plan to implement these methods in the future. Despite strongly expressed views about the pros and cons of alternative forms of consultation, these are largely speculative.

The single page survey opened with questions about the age and sex of the responder, followed by two groups of questions. In one group, participants were asked whether their practice currently provided, or planned to provide, consultations with patients via email or electronic messaging, internet video, or telephone. The survey asked participants about the use of bookable telephone consultations (not including triage calls or brief messages) so as to focus on the use of the telephone to replace face-to-face consultations, not as an initial assessment of urgency. Telephone triage is being assessed in more detail in another concurrent research project.²³ In the other group of questions, participants were asked how often they personally conducted consultations using each of these approaches. Each question in both groups was scored on a 5-point Likert scale. The questionnaire closed with the opportunity for responders to add information ‘about any interesting or unusual ways in which you use these different approaches’ in a free text box (Appendix 1).

Practices within the English study sites were identified through the relevant clinical commissioning groups’ websites. For the practices in Scotland, details were retrieved from the Information Services Division: ISD Scotland website. Information about the practice managers, GP partners, and salaried GPs were accessed via the practice website if one existed. For those practices without a website (53/421, 13%), the information was gained through a telephone call to the practice.

The questionnaires were posted to each of the practice managers, GP partners, and salaried GPs, with the aim of receiving at least one response from each practice. If no response had been received after a period of 2 weeks, a postal reminder was sent to all the GPs and the practice manager within the practice, and 2 weeks after this a telephone reminder was made, if appropriate, to the practice manager.

The primary analysis was at a practice level, with analysis of GPs’ personal use of alternative forms of consultation at an individual level. Numerical data were analysed using simple statistical methods supported by Excel 2013 and Stata (version 13.1). When different responses were given by responders within the same practice the authors used the mean result at practice level, rounding to the nearest whole number. The authors explored the extent of variation in response by different individuals within the same practice using the within-practice standard deviation (SD) and the intraclass correlation coefficient (ICC). Responses regarding GPs’ own use of alternatives to face-to-face consultation were analysed at individual responder level, and responses from practice managers were excluded from these analyses.

The results from the free text box were analysed thematically using QSR NVivo (version 10) and a visual mind-mapping approach to examining groupings and patterns in the data.²⁴

RESULTS

Response rate

Of the practices approached, 163/186 (88%) of practices in England and 156/235 (66%) of practices in Scotland responded, giving an overall practice response rate of 76% (n = 319/421). In addition, 40% of English and 25% of Scottish surveys were returned, with an overall individual response rate of 33% (n = 889/2719). The number of responses per practice ranged from 1–11.

Profile of responders

Participating practices were larger (in terms of numbers of registered patients and doctors per practice) than those who did not participate. There were no significant differences between practices in their deprivation score (Table 1). Of the 696 responders who reported their sex, 59% (413/696) were female. Responders categorised their ages as: 25–34 years (n = 90/889, 10%); 35–44 years (n = 239/889, 27%); 45–54 years (n = 362/889, 41%); and ≥55 years (n = 189/889, 21%). Of all responses, 12% (105/889) came from practice managers, and 88% (784/889) from doctors.

View this table:

Table 1.

Characteristics of the practices that responded to the survey, compared to practices that did not respond

The current and planned use of alternatives to face-to-face consultations at practice level

Although the majority of practices reported routinely offering telephone consultations, few (6%) currently provided email consultations (Table 2). More than half of practices had no plans to introduce email consultations in future, although 20% stated that they intended to do so. None of the responder practices reported offering internet video consultations and very few reported any plans to do so in future. There was also evidence that 21% of practices had previously offered email, and that 10% had previously offered internet video, but that they had subsequently withdrawn these services.

View this table:

Table 2.

Practice-level plans to introduce alternatives to face-to-face consultations (n = 421)^a

There was some disagreement between responders within the same practice about their practices’ use of telephone (within-practice SD 0.91; ICC 0.53) or email consultations (SD 1.1; ICC 0.39). There was less variation between responders about their practices’ use of video consultation (SD 0.52; ICC 0.20), related to the very limited use of these consultations in general.

The current provision of alternatives to face-to-face consultations at an individual GP level

The majority of GPs reported personally providing telephone consultations most or every working day (79%). Only 8% reported providing email consultations most or every working day, 45% did so rarely or sometimes, and just under half (47%) never provide email consultations. Furthermore, 99% stated that they never conduct consultations via internet video (Table 3).

View this table:

Table 3.

Individual GPs’ use of alternatives to face-to-face consultations (n = 784)

Provision of telephone, email, or video consultations did not vary by GP age or sex, or by study site (data not shown).

Thematic analysis of free-text

All responders were invited to complete a free text box to ‘Highlight any interesting or unusual ways in which you use these different approaches as an alternative to face-to-face consulting,’ and 249/889 (28%) of the responses included some form of free text.

Rather than answering the question posed, the majority of the responders described their views (usually resistance) on the idea of introducing email or video consultations. Only a few opinions were related to actual experience, although this did not prevent objections from being strongly expressed, for example: ‘Only politicians and the naive would think this a good idea.’

Concerns expressed included the view that adopting email or video consultation would be inefficient for the practice, would increase demand, would be a challenge in terms of privacy and confidentiality, and would increase clinical risk, with medicolegal consequences. A few GPs had experience of some vulnerable and older people who preferred alternative consultation methods, while others thought that these same groups would be disadvantaged. Practical issues, such as the reliance on appropriate internet provision and broadband reliability, the financial outlay, and local concerns about information governance, were mentioned as further barriers to implementation (Box 1).

Box 1.

Free-text quotes that are illustrative of the concerns identified relating to the introduction of alternatives to face-to-face consultations

Concerns for GPs

Increased access:
- ‘Increasing access options increases GP stress :(’
- ‘Email is a nightmare — access all the time, and hundreds of emails.’
Increase clinical risk:
- ‘It’s a personal preference, but I find the increased access too intrusive and increases risk of information getting lost/filed with other documents.’
- ‘We have discussed use of email communication but find there is a risk of emails not being acted upon when certain GPs are on leave, leading to unnecessary risk and delay.’
- ‘I feel the level of risk with these are higher than a face-to-face or phone.’

Concerns for practices

Increased workload:
- ‘If we take on email consultations, we will have possibly hundreds of emails. Who will deal with them? … medicolegal consequences of delay. We have no capacity. This will possibly increase workload.’
- ‘We already get more than 100 emails EACH daily. This would open the floodgates and we would drown. It is unmanageable.’
Privacy and confidentiality:
- ‘Issue with confidentiality using email.’
- ‘Query issues with medicolegal problems and confidentiality.’
Challenge of technology:
- ‘Internet connection currently barely up to current software requirements for e-referrals etc. Don’t have software and hardware capacity for more modern techniques.’

Concerns around patients

Disadvantage certain groups, such as the older people:
- ‘Concern that most vulnerable (deaf/blind/elderly/demented/mentally ill) least able to access, and so unintentionally disadvantaged.’
- ‘Very elderly population — technology difficult.’

A few responders mentioned experience of benefits, such as patients being able to send pictures of a transient rash or an audio file of a child’s cough, or those who preferred to use email because of communication difficulties or disabilities that made it difficult to get to the surgery. Some also mentioned using email with particular ‘selected’ patients, and being in email contact with their own GPs (Box 2).

Box 2.

Free-text quotes that are illustrative of the benefits identified relating to the introduction of alternatives to face-to-face consultations

Benefits for GPs

Used to support the face-to-face consultation:
- ‘I think patients using media — for example, bringing in photos of their transient rashes, or recordings of their babies cough — are great.’
- ‘In combination with phone consult (and with consent), I have got patients to text me photos of problem — for example, rash, eye inflammation — to help confirm diagnosis or whether need to be seen etc.’
- ‘Would be good to do one way doc–patient communications instead of letters.’

Benefits for practices

Workload management:
- ‘We encourage patients to use email to send info to us (stops clogging up the phone lines).’

Benefits for patients

Advantage for those with physical or communication difficulties:
- ‘I use email for one patient who has MND [motor neurone disease] and so cannot speak on phone.’
- ‘Email really helpful for deaf patients (who sometimes send me an email before attending a consultation to save time), and for tracheostomy patients.’

DISCUSSION

Summary

The findings from this survey suggest that, although most practices offer telephone consultations on a frequent basis, email is used infrequently and very few have ever used internet video for consultations with patients. In addition, 10% of the responders said that their practice had tried video consultations but had now stopped. Furthermore, few practices plan to implement these consultation methods in the future. This same picture is replicated in the individual responses. Moreover, these findings remain constant regardless of responders’ age, sex, or region (data not shown).

Despite the policy pressure to introduce consultations by email and internet video, there is little actual use of these, and a general reluctance among GPs to implement alternatives to face-to-face consultations. The survey and free text responses underline that both the reluctance and enthusiasm for these alternatives are mainly speculative and reflect the fears of the profession around their burgeoning workload. The limited responses to the free-text element of the survey are indicative of wider concerns. They match what is reported in the existing literature and are being explored in depth in a forthcoming focused ethnography.

Strengths and limitations

This appears to be the first survey designed to assess the use, and planned use, of alternatives to face-to-face consultation in primary care. In this postal survey of general practice in five areas of England and Scotland the authors obtained at least one response from a high proportion of practices (76%). These practices appeared to be representative of all practices approached in terms of size, region, and deprivation. The large number of practices represented in this survey is a strength of this study. The use of free text comments, as well as the closed questions of the survey, has added to the understanding of GPs’ concerns, but such data are limited in comparison with other qualitative methods.

Areas were chosen for this survey to include practices with a range of characteristics: from urban to rural, inner city to remote, and from affluent to deprived locations. Such practices may have differing incentives to implement alternatives to face-to-face consultations, and there will always be local policy differences to take into consideration too. The authors acknowledge that practices in other areas of the UK may be using these and other alternatives to face-to-face consultations.

Offering consultations using an alternative medium is controversial. Therefore it is possible that some responders would be reluctant to admit to using email or internet video. Furthermore, there is a risk of a response bias, particularly with the free text responses. Those who respond may have a particular standpoint on the subject of enquiry.²⁵ As such, the authors acknowledge that the findings from this survey may not necessarily be generalisable, although they offer an insight into the current use of alternatives to face-to-face consultations.

Comparison with existing literature

Although the use of alternatives to face-to-face consultations had been recognised previously,²⁶ the level of such activity reported in this study is less than previous estimates reported from surveys conducted in Europe.²⁷^,²⁸ Furthermore, in contrast to popular belief, fewer practices offer email or internet video consultations than often envisaged.²⁹

In 2012, the policy of the UK Department of Health was for patients to be able to communicate electronically with their health and care team by 2015.³⁰ This target has not been achieved, but several pilots have been funded by the PMCF⁷ which examines the use of email and other electronic means of consultation with patients. However, as recommended in the recent report by the Primary Care Workforce Commission, more evidence is required before email or internet video consultations can be recommended as a routine part of primary care.³¹

This research identified that some responders felt the need to resist a perceived pressure to adopt alternative approaches to consultations that have been claimed to have a potentially transformative impact on general practice.⁵ This is despite proposed advantages in terms of access and resource use,²⁹ particularly as the use of the web, telephone, or text would be a natural development based on their use in other spheres of life.³² The free-text responses revealed concerns about the perceived risks to patients, the organisation, and practice staff. This finding echoes the concerns voiced in recent surveys of GPs’ attitudes towards the use of alternatives to face-to-face consultations.¹⁶^,¹⁹^,²² Similarly, the concern found in the literature about how and when to use alternatives to face-to-face consultations was upheld.²⁰^,²¹ However, 21% of practices reported having tried using email, and 10% using internet video, despite a general antipathy towards their introduction, and had since reduced such use. This may provide support for these concerns. There were also a few positive accounts of experiences and an acknowledgement of when, how, and for whom these alternatives may be beneficial, reflecting previously reported findings.¹¹^,²⁰^,³³

Implications for research and practice

Due to the limited use of email or internet video within the responder group, in keeping with previous literature, the concerns listed are based primarily on perception and anecdote.²¹ This general reluctance to adopt alternatives to face-to-face consultations is therefore unlikely to change without a change in policy. As recommended in the recent report by the Primary Care Workforce Commission, more evidence is required before email or internet video consultations can be recommended as a routine part of primary care.³¹

This survey is the precursor to a focused ethnographic study of practices who either currently offer, are about to introduce, or have ceased to offer, an alternative method of consultation. This will focus on experiences and opinions when use is realised and not hypothesised.

Acknowledgments

The authors thank all of those who completed the survey, Kerry Walker who provided administrative support, Richard Morris for statistical advice, and Sally Stevens who formatted the questionnaire.

Appendix 1.

Postal questionnaire sent to practice managers, GP partners, and salaried GPs.

Notes

Funding

This study was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (reference number: 13/59/08). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health. Helen Atherton was funded by a National Institute for Health Research (NIHR) School for Primary Care Research (SPCR) fellowship. Sue Ziebland is an NIHR Senior Investigator.

Ethical approval

Not applicable.

Provenance

Freely submitted; externally peer reviewed.

Competing interests

The authors have declared no competing interests.

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Contribute and read comments about this article: bjgp.org/letters

Received November 9, 2015.
Revision requested December 19, 2015.
Accepted February 3, 2016.

REFERENCES

1.↵
1. Edirippulige S,
2. Levandovskaya M,
3. Prishutova A
(2013) A qualitative study of the use of Skype for psychotherapy consultations in the Ukraine. J Telemed Telecare 19(7):376–378.
OpenUrl CrossRef PubMed
2.
1. Newhouse N,
2. Lupiáñez-Villanueva F,
3. Codagnone C,
4. Atherton H
(2015) Patient use of email for health care communication purposes across 14 European countries: an analysis of users according to demographic and health-related factors. J Med Internet Res 17(3):e58.
OpenUrl PubMed
3.
1. Rhodan M
(Sep 16, 2013) Time, Saving U.S. health care with Skype. Lawmakers and proponents of telemedicine have begun exploring how technology can improve the health care system in the wake of Obamacare. http://swampland.time.com/2013/09/16/saving-u-s-health-care-with-skype/ (accessed 27 Apr 2016).
4.↵
1. Scharwz F,
2. Ward J,
3. Willcock S
(2014) E-health readiness in outback communities: an exploratory study. Rural Remote Health 14(3):2871.
OpenUrl PubMed
5.↵
1. Campbell JL,
2. Fletcher E,
3. Britten N,
4. et al.
(2014) Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis. Lancet 384(9957):1859–1868.
OpenUrl CrossRef PubMed
6.↵
1. Department of Health/NHS England
(2014) Transforming primary care: Safe, proactive, personalised care for those who need it most, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdf (accessed 27 Apr 2016).
7.↵
1. NHS England
(2015) Prime Minister’s Challenge Fund, http://www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/pm-ext-access/ (accessed 27 Apr 2016).
8.↵
1. Whitfield L
(May 20, 2015) Digitalhealthnet, Lib Dem manifesto promises GPs by Skype. http://www.digitalhealth.net/news/29852/lib-dem-manifesto-promises-gps-by-skype (accessed 27 Apr 2016).
9.↵
1. Wheeler B
(Sep 30, 2014) BBC, David Cameron promises seven-day GP access by 2020. http://www.bbc.co.uk/news/uk-politics-29415929 (accessed 27 Apr 2016).
10.↵
1. Atherton H,
2. Sawmynaden P,
3. Sheikh A,
4. et al.
(2012) Email for clinical communication between patients/caregivers and healthcare professionals. Cochrane Database Syst Rev 11:CD007978.
OpenUrl PubMed
11.↵
1. Bunn F,
2. Byrne G,
3. Kendall S
(2004) Telephone consultation and triage: effects on health care use and patient satisfaction. Cochrane Database Syst Rev 4:CD004180.
OpenUrl PubMed
12.↵
1. Zhou YY,
2. Kanter MH,
3. Wang JJ,
4. Garrido T
(2010) Improved quality at Kaiser Permanente through e-mail between physicians and patients. Health Aff 29(7):1370–1375.
OpenUrl Abstract/FREE Full Text
13.↵
1. Palen TE,
2. Ross C,
3. Powers J,
4. Xu S
(2012) Association of online patient access to clinicians and medical records with use of clinical services. JAMA 308(19):2012–2019.
OpenUrl CrossRef PubMed
14.↵
1. Hanna L,
2. May C,
3. Fairhurst K
(2011) Non-face-to-face consultations and communications in primary care: the role and perspective of general practice managers in Scotland. Inform Prim Care 19(1):17–24.
OpenUrl PubMed
15.↵
1. Neville RG,
2. Marsden W,
3. McCowan C,
4. et al.
(2004) A survey of GP attitudes to and experiences of email consultations. Inform Prim Care 12(4):201–206.
OpenUrl CrossRef PubMed
16.↵
1. British Medical Association
(2013) Developing general practice today: Providing healthcare solutions for the future, http://healthwatchhillingdon.org.uk/wp-content/uploads/downloads/2013/11/BMA-Developing-General-Practice-report.pdf (accessed 27 Apr 2016).
17.
1. Royal College of General Practitioners
(2014) An inquiry into Patient Centred Care in the 21st century Implications for general practice and primary care, http://www.rcgp.org.uk/policy/rcgp-policy-areas/~/media/Files/Policy/A-Z-policy/RCGP-Inquiry-into-Patient-Centred-Care-in-the-21st-Century.ashx (accessed 27 Apr 2016).
18.↵
1. Royal College of General Practitioners
(2015) Patient access to general practice: ideas and challenges from the front line, http://www.rcgp.org.uk/policy/~/media/Files/Policy/A-Z-policy/Patient-access-to-general-practice-2015.ashx (accessed 27 Apr 2016).
19.↵
1. Whitfield L. Netscape navigators
(Feb 26, 2013) Digitalhealth.net, http://www.digitalhealth.net/features/43883/ (accessed 27 Apr 2016).
20.↵
1. Atherton H,
2. Pappas Y,
3. Heneghan C,
4. Murray E
(2013) Experiences of using email for general practice consultations: a qualitative study. Br J Gen Pract doi:10.3399/bjgp13X674440.
OpenUrl Abstract/FREE Full Text
21.↵
1. Hanna L,
2. May C,
3. Fairhurst K
(2012) The place of information and communication technology-mediated consultations in primary care: GPs’ perspectives. Fam Pract 29(3):361–366.
OpenUrl CrossRef PubMed
22.↵
1. British Medical Association
(2015) National survey of GPs: the future of general practice 2015 (BMA, London).
23.↵
1. National Institute for Health Research. Evaluations, Trials and Studies
HS&DR — 13/59/40: Tele-First: Telephone triage as an alternative to face to face contact in general practice, http://www.nets.nihr.ac.uk/projects/hsdr/135940 (accessed 27 Apr 2016).
24.↵
1. Ziebland S,
2. McPherson A
(2006) Making sense of qualitative data analysis: an introduction with illustrations from DIPEx (personal experiences of health and illness). Med Educ 40(5):405–414.
OpenUrl CrossRef PubMed
25.↵
1. Cockburn J,
2. Campbell E,
3. Gordon JJ,
4. Sanson-Fisher RW
(1988) Response bias in a study of general practice. Fam Pract 5(1):18–23.
OpenUrl CrossRef PubMed
26.↵
(Feb 22, 2013) Digitalhealth.net, You don’t have mail consultations. http://www.digitalhealth.net/news/28289/you-don’t-have-mail-consultations (accessed 27 Apr 2016).
27.↵
1. Ortega Egea JMO,
2. González MVR,
3. Menéndez MR
(2010) eHealth usage patterns of European general practitioners: a five-year (2002–2007) comparative study. Int J Med Inform 79(8):539–553.
OpenUrl CrossRef PubMed
28.↵
1. Bertelsen P,
2. Petersen LS
(2015) Danish citizens and general practitioners’ use of ICT for their mutual communication. Stud Health Technol Inform 216:376–379.
OpenUrl PubMed
29.↵
1. Armstrong S
(2015) Finally, the NHS goes digital. Or does it? BMJ 351:h3726.
OpenUrl FREE Full Text
30.↵
1. Department of Health
(2012) The power of information: putting all of us in control of the health and care information we need, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213689/dh_134205.pdf (accessed 27 Apr 2016).
31.↵
1. Health Education England
(2015) The future of primary care: creating teams for tomorrow. Report by the Primary Care Workforce Commission, https://www.hee.nhs.uk/sites/default/files/documents/WES_The-future-of-primary-care.pdf (accessed 27 Apr 2016).
32.↵
1. Dixon A
(2008) Engaging patients in their health: how the NHS needs to change: Report from the Sir Roger Bannister Health Summit, Leeds Castle, 17–18 May 2007 (The King’s Fund, London).
33.↵
1. Bishop TF,
2. Press MJ,
3. Mendelsohn JL,
4. Casalino LP
(2013) Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff 32(8):1361–1367.
OpenUrl Abstract/FREE Full Text

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[1] 1.↵
Edirippulige S,
Levandovskaya M,
Prishutova A
(2013) A qualitative study of the use of Skype for psychotherapy consultations in the Ukraine. J Telemed Telecare 19(7):376–378.
OpenUrl CrossRef PubMed

[2] Edirippulige S,

[3] Levandovskaya M,

[4] Prishutova A

[5] 2.
Newhouse N,
Lupiáñez-Villanueva F,
Codagnone C,
Atherton H
(2015) Patient use of email for health care communication purposes across 14 European countries: an analysis of users according to demographic and health-related factors. J Med Internet Res 17(3):e58.
OpenUrl PubMed

[6] Newhouse N,

[7] Lupiáñez-Villanueva F,

[8] Codagnone C,

[9] Atherton H

[10] 3.
Rhodan M
(Sep 16, 2013) Time, Saving U.S. health care with Skype. Lawmakers and proponents of telemedicine have begun exploring how technology can improve the health care system in the wake of Obamacare. http://swampland.time.com/2013/09/16/saving-u-s-health-care-with-skype/ (accessed 27 Apr 2016).

[11] Rhodan M

[12] 4.↵
Scharwz F,
Ward J,
Willcock S
(2014) E-health readiness in outback communities: an exploratory study. Rural Remote Health 14(3):2871.
OpenUrl PubMed

[13] Scharwz F,

[14] Ward J,

[15] Willcock S

[16] 5.↵
Campbell JL,
Fletcher E,
Britten N,
et al.
(2014) Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis. Lancet 384(9957):1859–1868.
OpenUrl CrossRef PubMed

[17] Campbell JL,

[18] Fletcher E,

[19] Britten N,

[20] et al.

[21] 6.↵
Department of Health/NHS England
(2014) Transforming primary care: Safe, proactive, personalised care for those who need it most, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdf (accessed 27 Apr 2016).

[22] Department of Health/NHS England

[23] 7.↵
NHS England
(2015) Prime Minister’s Challenge Fund, http://www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/pm-ext-access/ (accessed 27 Apr 2016).

[24] NHS England

[25] 8.↵
Whitfield L
(May 20, 2015) Digitalhealthnet, Lib Dem manifesto promises GPs by Skype. http://www.digitalhealth.net/news/29852/lib-dem-manifesto-promises-gps-by-skype (accessed 27 Apr 2016).

[26] Whitfield L

[27] 9.↵
Wheeler B
(Sep 30, 2014) BBC, David Cameron promises seven-day GP access by 2020. http://www.bbc.co.uk/news/uk-politics-29415929 (accessed 27 Apr 2016).

[28] Wheeler B

[29] 10.↵
Atherton H,
Sawmynaden P,
Sheikh A,
et al.
(2012) Email for clinical communication between patients/caregivers and healthcare professionals. Cochrane Database Syst Rev 11:CD007978.
OpenUrl PubMed

[30] Atherton H,

[31] Sawmynaden P,

[32] Sheikh A,

[33] et al.

[34] 11.↵
Bunn F,
Byrne G,
Kendall S
(2004) Telephone consultation and triage: effects on health care use and patient satisfaction. Cochrane Database Syst Rev 4:CD004180.
OpenUrl PubMed

[35] Bunn F,

[36] Byrne G,

[37] Kendall S

[38] 12.↵
Zhou YY,
Kanter MH,
Wang JJ,
Garrido T
(2010) Improved quality at Kaiser Permanente through e-mail between physicians and patients. Health Aff 29(7):1370–1375.
OpenUrl Abstract/FREE Full Text

[39] Zhou YY,

[40] Kanter MH,

[41] Wang JJ,

[42] Garrido T

[43] 13.↵
Palen TE,
Ross C,
Powers J,
Xu S
(2012) Association of online patient access to clinicians and medical records with use of clinical services. JAMA 308(19):2012–2019.
OpenUrl CrossRef PubMed

[44] Palen TE,

[45] Ross C,

[46] Powers J,

[47] Xu S

[48] 14.↵
Hanna L,
May C,
Fairhurst K
(2011) Non-face-to-face consultations and communications in primary care: the role and perspective of general practice managers in Scotland. Inform Prim Care 19(1):17–24.
OpenUrl PubMed

[49] Hanna L,

[50] May C,

[51] Fairhurst K

[52] 15.↵
Neville RG,
Marsden W,
McCowan C,
et al.
(2004) A survey of GP attitudes to and experiences of email consultations. Inform Prim Care 12(4):201–206.
OpenUrl CrossRef PubMed

[53] Neville RG,

[54] Marsden W,

[55] McCowan C,

[56] et al.

[57] 16.↵
British Medical Association
(2013) Developing general practice today: Providing healthcare solutions for the future, http://healthwatchhillingdon.org.uk/wp-content/uploads/downloads/2013/11/BMA-Developing-General-Practice-report.pdf (accessed 27 Apr 2016).

[58] British Medical Association

[59] 17.
Royal College of General Practitioners
(2014) An inquiry into Patient Centred Care in the 21st century Implications for general practice and primary care, http://www.rcgp.org.uk/policy/rcgp-policy-areas/~/media/Files/Policy/A-Z-policy/RCGP-Inquiry-into-Patient-Centred-Care-in-the-21st-Century.ashx (accessed 27 Apr 2016).

[60] Royal College of General Practitioners

[61] 18.↵
Royal College of General Practitioners
(2015) Patient access to general practice: ideas and challenges from the front line, http://www.rcgp.org.uk/policy/~/media/Files/Policy/A-Z-policy/Patient-access-to-general-practice-2015.ashx (accessed 27 Apr 2016).

[62] Royal College of General Practitioners

[63] 19.↵
Whitfield L. Netscape navigators
(Feb 26, 2013) Digitalhealth.net, http://www.digitalhealth.net/features/43883/ (accessed 27 Apr 2016).

[64] Whitfield L. Netscape navigators

[65] 20.↵
Atherton H,
Pappas Y,
Heneghan C,
Murray E
(2013) Experiences of using email for general practice consultations: a qualitative study. Br J Gen Pract doi:10.3399/bjgp13X674440.
OpenUrl Abstract/FREE Full Text

[66] Atherton H,

[67] Pappas Y,

[68] Heneghan C,

[69] Murray E

[70] 21.↵
Hanna L,
May C,
Fairhurst K
(2012) The place of information and communication technology-mediated consultations in primary care: GPs’ perspectives. Fam Pract 29(3):361–366.
OpenUrl CrossRef PubMed

[71] Hanna L,

[72] May C,

[73] Fairhurst K

[74] 22.↵
British Medical Association
(2015) National survey of GPs: the future of general practice 2015 (BMA, London).

[75] British Medical Association

[76] 23.↵
National Institute for Health Research. Evaluations, Trials and Studies
HS&DR — 13/59/40: Tele-First: Telephone triage as an alternative to face to face contact in general practice, http://www.nets.nihr.ac.uk/projects/hsdr/135940 (accessed 27 Apr 2016).

[77] National Institute for Health Research. Evaluations, Trials and Studies

[78] 24.↵
Ziebland S,
McPherson A
(2006) Making sense of qualitative data analysis: an introduction with illustrations from DIPEx (personal experiences of health and illness). Med Educ 40(5):405–414.
OpenUrl CrossRef PubMed

[79] Ziebland S,

[80] McPherson A

[81] 25.↵
Cockburn J,
Campbell E,
Gordon JJ,
Sanson-Fisher RW
(1988) Response bias in a study of general practice. Fam Pract 5(1):18–23.
OpenUrl CrossRef PubMed

[82] Cockburn J,

[83] Campbell E,

[84] Gordon JJ,

[85] Sanson-Fisher RW

[86] 26.↵
(Feb 22, 2013) Digitalhealth.net, You don’t have mail consultations. http://www.digitalhealth.net/news/28289/you-don’t-have-mail-consultations (accessed 27 Apr 2016).

[87] 27.↵
Ortega Egea JMO,
González MVR,
Menéndez MR
(2010) eHealth usage patterns of European general practitioners: a five-year (2002–2007) comparative study. Int J Med Inform 79(8):539–553.
OpenUrl CrossRef PubMed

[88] Ortega Egea JMO,

[89] González MVR,

[90] Menéndez MR

[91] 28.↵
Bertelsen P,
Petersen LS
(2015) Danish citizens and general practitioners’ use of ICT for their mutual communication. Stud Health Technol Inform 216:376–379.
OpenUrl PubMed

[92] Bertelsen P,

[93] Petersen LS

[94] 29.↵
Armstrong S
(2015) Finally, the NHS goes digital. Or does it? BMJ 351:h3726.
OpenUrl FREE Full Text

[95] Armstrong S

[96] 30.↵
Department of Health
(2012) The power of information: putting all of us in control of the health and care information we need, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213689/dh_134205.pdf (accessed 27 Apr 2016).

[97] Department of Health

[98] 31.↵
Health Education England
(2015) The future of primary care: creating teams for tomorrow. Report by the Primary Care Workforce Commission, https://www.hee.nhs.uk/sites/default/files/documents/WES_The-future-of-primary-care.pdf (accessed 27 Apr 2016).

[99] Health Education England

[100] 32.↵
Dixon A
(2008) Engaging patients in their health: how the NHS needs to change: Report from the Sir Roger Bannister Health Summit, Leeds Castle, 17–18 May 2007 (The King’s Fund, London).

[101] Dixon A

[102] 33.↵
Bishop TF,
Press MJ,
Mendelsohn JL,
Casalino LP
(2013) Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff 32(8):1361–1367.
OpenUrl Abstract/FREE Full Text

[103] Bishop TF,

[104] Press MJ,

[105] Mendelsohn JL,

[106] Casalino LP

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Using alternatives to face-to-face consultations: a survey of prevalence and attitudes in general practice

Abstract

INTRODUCTION

METHOD

How this fits in

RESULTS

Response rate

Profile of responders

The current and planned use of alternatives to face-to-face consultations at practice level

The current provision of alternatives to face-to-face consultations at an individual GP level

Thematic analysis of free-text

Free-text quotes that are illustrative of the concerns identified relating to the introduction of alternatives to face-to-face consultations

Free-text quotes that are illustrative of the benefits identified relating to the introduction of alternatives to face-to-face consultations

DISCUSSION

Summary

Strengths and limitations

Comparison with existing literature

Implications for research and practice

Acknowledgments

Appendix 1.

Notes

Funding

Ethical approval

Provenance

Competing interests

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