Alternatives to face-to-face GP consultations may be counterproductive

Alleviating staff workload and improving patient access by offering alternatives to face-to-face GP consultations may not be an efficient tactic, as revealed by the findings of a collaborative study led by Dr Helen Atherton from the University of Warwick.

Implementing alternatives to face-to-face GP consultations such as telephone, email, online, and video consultations may not prove to be an effective approach. The experience of practices that have implemented this suggested that changes in patient access and staff workload may be both modest and gradual. Whilst such alternatives could save GPs and members of society a lot of time, they are not the most efficient way to deal with illness. Students may particularly like the prospect of being able to discuss health concerns from their room while updating their to-do lists but such approaches to save time may prove to be counterproductive.

Whilst such alternatives could save GPs and members of society a lot of time, they are not the most efficient way to deal with illness

The findings published in the British Journal of General Practice are of an in-depth study that was a collaboration between the Universities of Bristol, Warwick, Oxford, Edinburgh, and Exeter. The study, called the Alt-Con project, was funded by the National Institute for Health Research (NIHR) that investigated the impact of technological alternatives to GP consultations in eight general practices. These practices were all different sizes, some in urban and others in rural areas, and located in different areas of socioeconomic deprivation in the UK.

The fieldwork team consisted of five researchers, out of which three were allocated two or three practices for data collection over a period of up to eight weeks. The staff participants at each practice were chosen by the three researchers and patients who took part in the study were ensured to have different characteristics in terms of age, sex, ethnicity, disability, frequency of attendance, and whether they had a long-term health condition.

The study, called the Alt-Con project, was funded by the National Institute for Health Research

General practices are encouraged as per the NHS policy, to introduce alternatives to GP consultations to reduce GP workload and increase patient access to healthcare however these findings suggest that these hoped-for changes may not be realised. The results highlighted some potential benefits to patients of the availability of such alternatives but significant barriers to implementation were identified.

The findings indicated a lack of clarity over the rationale for introducing such alternatives and the intended benefits. Practices were found to be introducing new technologies without considering the costs of implementation and the benefits to patients and practices. The study even found that sometimes the reasons for implementation were opportunistic rather than carefully considered.

The study even found that sometimes the reasons for implementation were opportunistic rather than carefully considered

Another challenge that was identified by the study was regarding staff training. Non-clinical staff, such as nurses and receptionists, may receive insufficient training on the use of the technologies appropriately. As a result, they may find themselves unable to communicate the benefits of such services to patients. Without clear understanding, patients might be left confused about the services available to them and therefore may miss out on services that they require. This would particularly be an issue, and arguably a greatly damaging one, in the case of mental health patients. Mental health illnesses are  common in the student population, and treatment can not only involve medication but an in-person discussion. A rapport could greatly improve the GPs’ ability to offer long-term support and guidance and therefore assist with recovery.

Professor Chris Salisbury from the University of Bristol’s Centre for Academic Primary Care said that the study identified a ‘tension’ between the efforts to finding a balance between making healthcare access easier for patients and reducing GP workload. He added that offering alternatives to receiving GP advice via technological means might increase the workload for GPs rather than decreasing it.

Mental health illnesses are  common in the student population, and treatment can not only involve medication but an in-person discussion

Dr Helen Atherton, from the University of Warwick and lead author of the study, added that “the availability of a wider range of options for consulting could be very helpful for some patient groups but has the potential to reduce the time the doctor has available for face-to-face consultations, which could disadvantage other patients.”

Atherton emphasises upon the need to take a tailored and well-thought approach by practices. A policy-driven approach, she highlights, that is incentivised by potential financial gains would not result in an efficient outcome. Guidance has been devised as part of the Alt-Con project that will enable GPs to construct their decisions while bearing in mind the needs of the practice population and the available resources.