Practice | Number of days spent in observation | Patient list size | Location of practicea | Deprivation score | Alternative to face-to-face consultation used |
---|---|---|---|---|---|
A | 25 | 18 353 | Inner city | Deprived 3 | Telephone consultations — open to all patients, with an ad-hoc approach to scheduling. The receptionist would send a message to the clinician asking them to ring the patient. There were no scheduled appointments for telephone consultations. E-consultationb — guided by a protocol, with an ad-hoc approach to scheduling. The practice was actively promoting the use of the e-consult software through advertising on the website, in the practice, and on the answerphone message |
B | 19 | 8954 | Inner city | Deprived 3 | Telephone consultations — open to all patients in a semi-structured way, with some appointments ringfenced for telephone consultations. The receptionist would add more if needed. It was actively promoted by the practice to manage demand |
C | 18 | 15 000 | Inner city | Mixed 4 | Telephone consultations — open to all patients in a semi-structured way, with some appointments ringfenced for telephone consultations. The receptionist would add more if needed. E-consultationb — guided by a protocol, with a structured approach to scheduling. The practice was actively promoting the use of the e-consult software through advertising on the website, in the practice, and on the answerphone message. Email — a Webform email was dealt with in the same manner as e-consultations. Less obvious on the website and not actively promoted |
D | 8 | 1938 | Rural | Mixed 5 | Telephone consultations — the GP had telephone slots (about six a day), and the receptionist would add more at the end of the day if needed. Video consultation — used as part of the communication with people living remotely. It was rarely used. Email — used occasionally to organise the practical aspects of care. An email address for administrative purposes was on the patient leaflet |
E | 17 | 7196 | Inner city | Deprived 1 | Telephone consultations — the practice used a patient callback system. This was as a scheduled 5-minute appointment. E-consultationsb — guided by a protocol, with a structured approach to scheduling. Email — a Webform email was dealt with in the same manner as e-consultations |
F | 25 | 13 778 | Semi-rural | Affluent 10 | Telephone consultations — open to all patients in a semi-structured way, with some appointments ringfenced for telephone consultations. The receptionist would send a message to the clinician asking them to ring the patient back when these had been filled. Actively promoted by the practice. A message is displayed in the waiting room promoting telephone consultations. Email — used by nurses to organise the practical aspects of care |
G | 16 | 13 511 | Semi-rural | Mixed 6 | Telephone consultations — open to all patients in a semi-structured way, with some appointments ringfenced for telephone consultations. Promoted as an alternative to face-to-face consultations |
H | 11 | 6597 | Inner city | Affluent 10 | Telephone consultations — open to all patients in an ad-hoc way by sending a message to the GP asking them to call the patient. Used once all face-to-face consultations booked. Cannot book in advance. There were no scheduled appointments for telephone consultations |
↵a Practices A–C and F–H measured by the Index of Multiple Deprivation score. Practices D and E measured by percentage of practice patients living in data zones defined as the 15% most deprived (population weighted).
↵b All those using e-consults in the study were piloting the use of the software for free. Email was used unofficially in all the case study sites, with GPs using email consultations for selected patients. The use of email by GPs did not involve the reception staff, except when the receptionist was expected to action a clinical response — that is, book appointments, communicate with patients, and so on.