Alternatives to the face-to-face consultation in General Practice: focused ethnographic case study

February 5, 2018

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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.


Funding :


This project was funded by the National Institute for Health Research (NIHR) [HS&DR programme] (project number 13/59/08) and hosted by Bristol NHS Clinical Commissioning Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, NHS, the Department of Health, or Bristol NHS Clinical Commissioning Group.


Ethical approval :


Ethical approval was obtained from the NHS Research and Ethics Committee Yorkshire and the Humber-South Yorkshire (15/ YH/0135). Consent for participation in semistructured interviews and the observation of consultations was obtained from primary care staff and participating patients. 


Authors :


H Atherton, PhD, assistant professor of primary care research, Warwick Medical School, University of Warwick, Coventry.


H Brant, PhD, senior research associate; C Salisbury, MD, professor of primary health care, Centre for Academic Primary Care, University of Bristol, Bristol.


S Ziebland, MSc, professor of medical sociology


T Porqueddu, PhD, research fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.


A Bikker, MSc, research fellow; B McKinstry, MD, professor of primary care e-health, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh.


J Campbell, MD, professor of general practice and primary care, University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter.


A Gibson, associate professor in patient and public involvement, Health and Social Sciences, University of the West of England, Bristol.


Address for correspondence : Helen Atherton, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.




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