Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Apr;68(669):e293-e300.
doi: 10.3399/bjgp18X694853. Epub 2018 Jan 29.

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

Helen Atherton  1 , Heather Brant  2 , Sue Ziebland  3 , Annemieke Bikker  4 , John Campbell  5 , Andy Gibson  6 , Brian McKinstry  4 , Tania Porqueddu  3 , Chris Salisbury  2
Affiliations
Multicenter Study

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

Helen Atherton et al. Br J Gen Pract. 2018 Apr.

Abstract

Background: NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives.

Aim: To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice.

Design and setting: Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016.

Method: Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report.

Results: Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal.

Conclusion: Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.

Keywords: communication; electronic mail; ethnography; general practice; qualitative research; remote consultation; workload.

PubMed Disclaimer

References

    1. Danish Government Den digitale vej til fremtidens velfærd. 2011. [Municipal libraries. The digital way to the future of well-being]. https://horsensbibliotek.dk/om-bibliotekerne/projekter/den-digitale-vej-... (accessed 18 Jan 2018)
    1. Danish Medical Association Aktivitet og økonomi i almen praksis. 2017. [Activity and economy in general practice]. https://www.laeger.dk/nyhed/aktivitet-og-oekonomi-i-almen-praksis (accessed 15 Jan 2018)
    1. Pearl R. Kaiser Permanente Northern California: current experiences with internet, mobile, and video technologies. Health Aff (Millwood) 2014;33(2):251–257. - PubMed
    1. Department of Health The power of information: putting all of us in control of the health and care information we need. 2012 https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil... (accessed 11 Jan 2018)
    1. NHS England General practice forward view. 2016 https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf (accessed 11 Jan 2018)

Publication types

LinkOut - more resources