Abstract
Background:
To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video or online consultation platforms.
Aim:
To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic.
Design and Setting:
Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire.
Methods:
Quantitative: Longitudinal observational analysis comparing volume and type of consultations in April-July 2020 with April-July 2019. Negative binomial models were used to identify if changes differed amongst different groups of patients.
Qualitative: 87 practice staff longitudinal interviews in four rounds investigated practices experience of the move to remote consulting, challenges faced and solutions. A thematic analysis utilised Normalisation Process Theory.
Results:
There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April-July 2020 compared to 2019; GPs/nurses maintained a focus on older patients, shielding patients and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased.
Conclusions:
The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video or online consultation platforms.
Aim:
To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic.
Design and Setting:
Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire.
Methods:
Quantitative: Longitudinal observational analysis comparing volume and type of consultations in April-July 2020 with April-July 2019. Negative binomial models were used to identify if changes differed amongst different groups of patients.
Qualitative: 87 practice staff longitudinal interviews in four rounds investigated practices experience of the move to remote consulting, challenges faced and solutions. A thematic analysis utilised Normalisation Process Theory.
Results:
There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April-July 2020 compared to 2019; GPs/nurses maintained a focus on older patients, shielding patients and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased.
Conclusions:
The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
| Original language | English |
|---|---|
| Article number | e166-e177 |
| Pages (from-to) | E166-E177 |
| Number of pages | 12 |
| Journal | British Journal of General Practice |
| Volume | 71 |
| Issue number | 704 |
| Early online date | 25 Feb 2021 |
| DOIs | |
| Publication status | Published - Mar 2021 |
Bibliographical note
Funding Information:This study was funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR). Additional funding for staff time was provided by NIHR Applied Research Collaboration West and One Care. Professor Chris Salisbury is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© The Authors
Research Groups and Themes
- Covid19
Keywords
- general practitioners
- online consultation
- remote consultation
- telephone
- consultation
- triage
Access to Document
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This is the final published version of the article (version of record). It first appeared online via Royal College of Genera Practitioners at https://doi.org/10.3399/BJGP.2020.0948. Please refer to any applicable terms of use of the publisher.
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