Skip to main content

Main menu

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • BJGP Open Accessibility Statement
    • Editorial Board
    • Editorial Fellowships
    • Audio Abstracts
    • eLetters
    • Alerts
    • BJGP Life
    • Research into Publication Science
    • Advertising
    • Contact
  • SPECIAL ISSUES
    • Artificial Intelligence in Primary Care: call for articles
    • Social Care Integration with Primary Care: call for articles
    • Special issue: Telehealth
    • Special issue: Race and Racism in Primary Care
    • Special issue: COVID-19 and Primary Care
    • Past research calls
    • Top 10 Research Articles of the Year
  • BJGP CONFERENCE →
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Alerts

Search

  • Advanced search
Intended for Healthcare Professionals
BJGP Open
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow BJGP Open on Instagram
  • Visit bjgp open on Bluesky
  • Blog
Intended for Healthcare Professionals
BJGP Open

Advanced Search

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • BJGP Open Accessibility Statement
    • Editorial Board
    • Editorial Fellowships
    • Audio Abstracts
    • eLetters
    • Alerts
    • BJGP Life
    • Research into Publication Science
    • Advertising
    • Contact
  • SPECIAL ISSUES
    • Artificial Intelligence in Primary Care: call for articles
    • Social Care Integration with Primary Care: call for articles
    • Special issue: Telehealth
    • Special issue: Race and Racism in Primary Care
    • Special issue: COVID-19 and Primary Care
    • Past research calls
    • Top 10 Research Articles of the Year
  • BJGP CONFERENCE →
Research

Clinical risk in remote consultations in general practice: findings from in-COVID-19 pandemic qualitative research

Rebecca Rosen, Sietse Wieringa, Trisha Greenhalgh, Claudia Leone, Sarah Rybczynska-Bunt, Gemma Hughes, Lucy Moore, Sara E Shaw, Joseph Wherton and Richard Byng
BJGP Open 2022; 6 (3): BJGPO.2021.0204. DOI: https://doi.org/10.3399/BJGPO.2021.0204
Rebecca Rosen
1 Nuffield Trust, London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: rebecca.rosen@nuffieldtrust.org.uk
Sietse Wieringa
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Trisha Greenhalgh
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Claudia Leone
1 Nuffield Trust, London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sarah Rybczynska-Bunt
3 Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gemma Hughes
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Gemma Hughes
Lucy Moore
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sara E Shaw
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Joseph Wherton
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Richard Byng
3 Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading

Article Figures & Data

Tables

    • View popup
    Table 1. Data sources and methods
    Title, funder, and datesKey focus and settingFull sample and outline methodsSubset 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 studiesVideo 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.
    • View popup
    Table 2. Six kinds of risk associated with remote consultations
    DomainRisks 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

    • View popup
    Table 3. Mitigation actions to address risks in remote general practice consultations
    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

    During 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

    Supporting patients and staff
    • 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

    Addressing the needs of the wider population
    • 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

Back to top
Previous ArticleNext Article

In this issue

BJGP Open
Vol. 6, Issue 3
September 2022
  • Table of Contents
  • Index by author
Download PDF
Email Article

Thank you for recommending BJGP Open.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Clinical risk in remote consultations in general practice: findings from in-COVID-19 pandemic qualitative research
(Your Name) has forwarded a page to you from BJGP Open
(Your Name) thought you would like to see this page from BJGP Open.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Clinical risk in remote consultations in general practice: findings from in-COVID-19 pandemic qualitative research
Rebecca Rosen, Sietse Wieringa, Trisha Greenhalgh, Claudia Leone, Sarah Rybczynska-Bunt, Gemma Hughes, Lucy Moore, Sara E Shaw, Joseph Wherton, Richard Byng
BJGP Open 2022; 6 (3): BJGPO.2021.0204. DOI: 10.3399/BJGPO.2021.0204

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Clinical risk in remote consultations in general practice: findings from in-COVID-19 pandemic qualitative research
Rebecca Rosen, Sietse Wieringa, Trisha Greenhalgh, Claudia Leone, Sarah Rybczynska-Bunt, Gemma Hughes, Lucy Moore, Sara E Shaw, Joseph Wherton, Richard Byng
BJGP Open 2022; 6 (3): BJGPO.2021.0204. DOI: 10.3399/BJGPO.2021.0204
del.icio.us logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • Abstract
    • How this fits in
    • Introduction
    • Method
    • Results
    • Discussion
    • Notes
    • References
  • Figures & Data
  • Info
  • eLetters
  • PDF

Keywords

  • remote consultations
  • clinical risk
  • General Practice
  • family practice
  • telemedicine
  • safeguarding

More in this TOC Section

  • Low-density lipoprotein cholesterol levels and treatment intensity in secondary prevention of patients with ischaemic heart disease in the primary care setting: a real-world data registry study
  • General practitioner characteristics and video use in out-of-hours primary care: a register-based study
  • The impact of COVID-19 lockdowns on primary care contact among vulnerable populations in England: a controlled interrupted time series study
Show more Research

Related Articles

Cited By...

Intended for Healthcare Professionals

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Latest articles
  • Authors & reviewers
  • Accessibility statement

RCGP

  • British Journal of General Practice
  • BJGP for RCGP members
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP Open
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP Open: research
  • Writing for BJGP Open: practice & policy
  • BJGP Open editorial process & policies
  • BJGP Open ethical guidelines
  • Peer review for BJGP Open

CUSTOMER SERVICES

  • Advertising
  • Open access licence

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Open Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: bjgpopen@rcgp.org.uk

BJGP Open is an editorially-independent publication of the Royal College of General Practitioners

© 2025 BJGP Open

Online ISSN: 2398-3795