Unintended consequences of online consultations: a qualitative study in UK primary care

Andrew J Turner*, Rebecca L Morris, Dylan Rakhra, Fiona Stevenson, Lorraine McDonagh, Fiona Hamilton, Helen Atherton, Michelle C Farr, Sarah E Blake, Jonathan P Banks, Gemma Lasseter, Sue Zeibland, Emma Hyde, John Powell, Jeremy Horwood

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

30 Citations (Scopus)
48 Downloads (Pure)


Health services are increasingly using digital tools to deliver care and online consultations are being widely adopted in primary care settings. The intended consequences of online consultations are to increase patient access to care and increase the efficiency of care.

To identify and understand the unintended consequences of online consultations in primary care.

Design and Setting
Qualitative interview study in eight general practices using online consultation tools in South West and North West England.

Thematic analysis of semi-structured interviews with 19 patients and 18 general practice staff.

We identified consequences of online consultations that restricted patient access to care by making it difficult for some patients to communicate effectively with a GP and disadvantaging digitally-excluded patients. This stemmed from patient uncertainty about how their queries were dealt with and whether practices used online consultations as their preferred method for patients to contact the practice. We identified consequences that limited increases in practice efficiency by creating additional work, isolation and dissatisfaction for some staff.

Unintended consequences often present operational challenges that are foreseeable and partly preventable. However these challenges must be recognised and solutions resourced sufficiently. Not everyone may benefit and local decisions will need to be made about trade-offs. Process changes tailored to local circumstances are critical to making effective use of online consultation tools.
Unintended consequences also present clinical challenges that result from asynchronous communication. Online consultation tools favour simple, well-formulated, information exchange that leads to diffuse relationships and a more transactional style of medicine.
Original languageEnglish
Number of pages10
JournalBritish Journal of General Practice
Publication statusPublished - 13 Dec 2021


  • digital first primary care
  • digital health
  • health services accessibility
  • online consultations
  • qualitative research
  • unintended consequences


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