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Title, funder, and dates Key focus and setting Full sample and outline methods Subset of data used in this analysis Remote-by-default care in the COVID-19 pandemic,UK research and innovation,June 2020–November 202111 Remote assessment of unwell patients with possible COVID-19 in general practice. Four locality-level case studies in South Wales, Oxfordshire, Plymouth, and south London. Qualitative interviews and focus groups (114 patients, 72 clinicians). Delphi study on clinical assessment (69 participants). Thirty national stakeholder interviews. Interviews with 46 clinicians and 12 patients. ‘Near Me’ evaluation,Scottish Government,August 2019–December 202012 Evaluation of Scotland’s video consultation services immediately before and during the COVID-19 pandemic, covering both primary and secondary care.What are the individual, organisational, and system-level challenges to introducing remote consultation services at pace and scale and routinising such services? 223 interviews across 17 sites with clinicians, healthcare, and third sector support workers, clinician and non-clinical managers, administrators, IT support staff, patients and their relatives, and national-level stakeholders. Ethnography across 11 sites. Preliminary NVivo (version 12) search for the term ‘risk’ in interviews with 120 clinicians and 21 patients followed by in-depth analysis of 23 clinician and 2 patient interviews. Video consultations,Health Foundation,June 2020–July 202110 Spread and scale-up of video consultation services in primary and secondary care in England, Scotland, Wales, and Northern Ireland.What are the individual, organisational, and system-level challenges to introducing video consultation services at pace and scale and routinising such services? National survey of 809 NHS staff. Interviews with 40 NHS staff, with 20 follow-ups across hospitals and general practice. 10 patient interviews plus 2 focus groups with 15 patients and public representatives in each.7 locality case studies, of which 3 were of video clinics in primary care. 20 policy documents reviewed. Interviews with 10 clinicians and 10 patients. TOTAL Interviews with 176 clinicians and 43 patients Data management for all studies Video and telephone recordings were transcribed, deidentified, transferred to a secure server, and uploaded to NVivo software (version 12) for detailed coding. Access to recordings and transcripts was available through the secure server to members of the research team, along with the coding framework and documents explaining the codes used. Domain Risks identified in this study 1. Practice set-up and organisationEstates, care pathways (including access), technologies (including security and privacy), workforce 1A. Insufficient appointments are available
1B. Care pathways are tortuous and involve double-handling
1C. Patients are unable to access care (including various kinds of digital exclusion)
1D. Patients choose not to access care (for example, because they do not think they are a priority)
1E. Technology is inadequate or breaks down
2. Communication and the clinical relationshipShort term: content and tone of communication within the consultation.Long term: building and maintaining a positive, trusting therapeutic relationship 2A. Information exchange is inadequate in both content and tone
2B. Consultations are overly transactional, with important concerns unsurfaced and loss of caring routines
2C. The therapeutic relationship is not established or becomes eroded
3. Quality of clinical careAll aspects of assessment, examination, and clinical management of patients 3A. Diagnoses are missed or delayed (for example, because physical examination is limited or impossible)
3B. Safeguarding is compromised (for example, through lack of privacy or inadequate information)
3C. Patients are over-investigated or over-treated to compensate for information deficits
4. Patient’s role in own careInforming and supporting the patient to play an active role in own care 4A. Excessive burden is placed on the patient to make judgements, navigate care pathways, convey their symptoms, monitor their own illness, and use equipment
4B. Opportunities for patient education and information-sharing are reduced
5. Population and public healthPreventive care, screening; societal and family aspects of health and illness 5A. Opportunities for screening and lifestyle advice are reduced
5B. Opportunities to understand and engage with the societal and family context of illness are reduced
6. Professional development and wellbeingSelf-care; maintaining professional attitudes and commitment; lifelong learning 6A. Clinical staff become stressed, burnt out, and demotivated
6B. Opportunities for learning and development are reduced
Design and delivery of services Provide training for all staff to identify patients’ ability to engage with remote consulting and offer appointments according to these abilities
Include patients as ‘co-designers’ of digital services and/or processes
Maintain varied access routes into general practice, including in-person attendance to book appointments
Support digital inclusion and preserve equity of access through actions such as peer-to-peer teaching provided by patient participation groups or signposting to local training in digital skills
Invest in digital infrastructure to reduce the risk of failed or disrupted consultations
Use remote consultations as one of several different modes to engage with patients in their individual contexts and swap between them when necessary and possible
Pay attention to screening, preventive care, and lifestyle advice while consulting remotely
Use training and guidance to build clinician skills in identifying and managing safeguarding concerns
Develop robust quality and safety assurance processes for remote consulting
Improve communications to patients about how to access online services, including what type of consultation works best for different health problems and the principles to be applied when choosing between different types of consultation
Provide training and guidance for all clinicians (see above) on how to use digital modes of access to general practice
Develop the role of care navigators and social prescribers to support highly vulnerable patients and others to access services and to navigate between providers
Work with external organisations to strengthen digital skills in vulnerable groups and to reduce digital exclusion
Monitor use of other services and onward referral rates following remote consultations
Ensure that population health initiatives and efforts to reduce inequalities are sustained alongside remote consulting
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