Remote care in UK general practice: baseline data on 11 case studies

Abstract

Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. Methods: Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. Results: Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features—notably system-level stressors such as high workload and staff shortages, and UK’s technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the ‘digital front door’ (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. Conclusions: General practices’ responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.

UK newspapers ‘on the warpath’: media analysis of general practice remote consulting in 2021

“…The current authors’ own ongoing empirical research has begun to identify similar findings among GPs and their support staff. 27 …”

“…A qualitative of 40 UK GPs conducted in 2020-2021 (25), and a social media analysis of GPs' postings during the pandemic by the same authors (26), both found that negative media portrayals of general practice (especially the implication that practices were closed when the reality consisted of long hours and high workload) were a significant factor contributing to low morale. Our own ongoing empirical research has begun to identify similar findings among GPs and their support staff (27).…”

Protocol: Remote care as the ‘new normal’? Multi-site case study in UK general practice

“…We have collected and analysed baseline data on all practices, which we have presented in a separate paper 102 .…”

“…We have collected and analysed baseline data on all practices, which we have presented in a separate paper 102 . Selected additional data on this ongoing, mainly qualitative study will be made available to researchers on reasonable request to the lead author (TG).…”

How can remote GP consultations be safer?

“…It combines research interviews and ethnography in 11 GP practices across the UK, along with patient learning sets and action-orientated research workshops. This small sample represents the range of triage and appointment booking options currently offered: some allow patients to choose their appointment type, some use online and telephone triage, and some operate a “telephone first” system 10. Early findings from this study suggest some avenues for improving safety.…”