Covid 19: a fork in the road for general practice

Gray, Denis Pereira; Freeman, George; Johns, Catherine; Roland, Martín

doi:10.1136/bmj.m3709

Cited by 34 publications

(38 citation statements)

References 12 publications

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“…In June 2020, the British Journal of General Practice was still publishing hopeful narratives, asking ‘ how does general practice identify, develop, and embed the positive changes [towards remote care] that are being implemented as a consequence of the crisis?’ (Marshall et al 2020). But by autumn 2020, remote care had begun to be depicted as potentially damaging to the core values of general practice because it carried risks and threatened the quality of the therapeutic relationship and continuity of care (Gray et al 2020; Swinglehurst et al 2020).…”

Section: Discussionmentioning

confidence: 99%

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‘From disaster, miracles are wrought’: a narrative analysis of UK media depictions of remote GP consulting in the COVID-19 pandemic using Burke’s pentad

2021

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During crises (major events characterised by uncertainty, urgency and threat), society must make sense of rapidly unfolding events. This happens mainly through narrativising—depicting a setting, characters and a meaningful sequence of events and actions unfolding over time. In the early months of the pandemic, UK general practice shifted from face-to-face consultations to a remote-by-default model (telephone, video or e-consultation). This shift was initially widely accepted by press and public, but support waned after a politician declared that the change would be permanent. We invoke Burke’s dramatistic pentad of act, scene, agent, agency and purpose to theorise findings from a detailed analysis of media coverage of the remote-by-default policy and reactions to it. We consider the 12 weeks from March to June 2020 (first lockdown, when remote-by-default services had just been introduced) and 1 week from late July 2020 (following the ministerial announcement). The initial introduction of remote consulting had strong narrative coherence in which all parts of the pentad were balanced: scene (a deadly virus threatening the country) aligned with act (lockdown, including avoiding face-to-face appointments unless essential), agents (the National Health Service and digital technology as heroic macro-actors), agency (general practitioners ‘deployed’) and purpose (to control the pandemic). The later period, however, was characterised by a mismatch between scene (a country emerging from lockdown and resuming normal life), act (imposition of the remote model), agent (a politician known for his enthusiasm for technology), agency (top-down directive) and purpose (modernisation). Whereas media narratives in the first period aligned with the genre of heroic adventure (suggesting a worthy battle, bravely fought), those of the second had characteristics of farce (something both comic and grotesque). We conclude that close reading of media narratives may surface potential misalignments between policy decisions and the context in which they must be implemented.

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Section: Discussionmentioning

confidence: 99%

“…Much has already been written about how doctors and other health professionals viewed the shift from face-to-face to remote consultations (Marshall et al 2020; Peek, Sujan, and Scott 2020; Greenhalgh et al 2020Gray et al 2020). In this paper, we consider how the mainstream media reacted to the introduction of a remote-by-default policy.…”

Section: Introductionmentioning

confidence: 99%

‘From disaster, miracles are wrought’: a narrative analysis of UK media depictions of remote GP consulting in the COVID-19 pandemic using Burke’s pentad

2021

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“…The form of the clinical interview has changed, and with it communication and the doctor-patient relationship; Before COVID-19, all communication techniques and doctor-patient relationship, which were considered tried and true to establish a good relationship with patients, involved physical proximity [2]. Now in many European countries and in the United States face-to-face consultations have been reduced to 10-20%, with most contacts now being provided remotely using symptom checkers, electronic messaging, and phone or video consultations [3]. the name of a prescription that needs to be repeated, the patient may be asked to go to the medicine cabinet to retrieve the bottle.…”

Section: Introductionmentioning

confidence: 99%

Post Covid-19 Doctor-Patient Relationship Model. Creation of Social Connection Contexts With Physical Distancing

Turabián

2020

IJGP

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The coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 has produced a significant change in the way general medicine is conducted. This shift has been remarkably quick towards telecare. The form of the clinical interview has changed, and with it communication and the doctor-patient relationship; Before COVID-19, all communication techniques and doctor-patient relationship, which were considered tried and true to establish a good relationship with patients, involved physical proximity 2. Now in many European countries and in the United States face-to-face consultations have been reduced to 10-20%, with most contacts now being provided remotely using symptom checkers, electronic messaging, and phone or video consultations 3.

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“…There is little knowledge regarding the impact of VCs on the doctor-patient relationship and to what extent a pre-existing doctor-patient relationship might impact the quality and outcome of VCs. The introduction of VCs in situations where GPs deliver continuity of care to their patients (relational continuity) and are familiar with their ongoing health problems (episodic continuity) may have a positive impact compared to situations where continuity of care is not established [17].…”

Section: Introductionmentioning

confidence: 99%

Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners (Preprint)

Johnsen¹,

Norberg²,

Kristiansen³

et al. 2020

Preprint

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BACKGROUND The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway. OBJECTIVE This study aims to document GPs’ experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic. METHODS A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs’ perceived suitability of the VCs, the nature of the patients’ main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests. RESULTS In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting. CONCLUSIONS Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs’ perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.

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Covid 19: a fork in the road for general practice

Cited by 34 publications

References 12 publications

‘From disaster, miracles are wrought’: a narrative analysis of UK media depictions of remote GP consulting in the COVID-19 pandemic using Burke’s pentad

‘From disaster, miracles are wrought’: a narrative analysis of UK media depictions of remote GP consulting in the COVID-19 pandemic using Burke’s pentad

Post Covid-19 Doctor-Patient Relationship Model. Creation of Social Connection Contexts With Physical Distancing

Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners (Preprint)

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