Remote by default general practice: must we, should we, dare we?

SIMPLISTIC POLICY; SPARSE EVIDENCE

The UK Secretary of State for Health and Social Care’s announcement that all consultations should henceforth be remote by default¹ recurred like a discordant leitmotif in the recent Royal College of General Practitioners’ virtual conference, A Fresh Approach to General Practice.² Speakers and audience members alike acknowledged that remote consulting has some real strengths, but recoiled from the idea of remote as the norm from which the traditional face-to-face consultation would deviate.

Most published research on remote consultations is either marginal to general practice (for example, trials of video appointments for hospital outpatients with chronic stable conditions)³ or lacking in granularity (for example, predominantly quantitative studies of telephone-first ‘demand management’).⁴ One detailed study of remote general practice consultations concluded that ‘efficiency’ gains, such as shorter consultations, may occur at the expense of other aspects of consultation quality, including information richness, shared decision making, and safety netting,⁵ though another interpretation of this non-randomised study is that more patients with complex problems book face-to-face. A randomised trial of telephone triage in general practice found an overall reduction in efficiency because of double-handling of problems.⁶ Studies of e-consultations⁷ and workload modelling⁸ came to similar conclusions.

A MORE COMPLEX REALITY

Clinicians …