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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 Shaw, Joseph Wherton and Richard Byng
BJGP Open 29 April 2022; BJGPO.2021.0204. DOI: https://doi.org/10.3399/BJGPO.2021.0204
Rebecca Rosen
1 Nuffield Trust, London, UK
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Sietse Wieringa
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Trisha Greenhalgh
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Claudia Leone
1 Nuffield Trust, London, UK
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Sarah Rybczynska-Bunt
3 University of Plymouth, Plymouth, UK
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Gemma Hughes
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Lucy Moore
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Sara Shaw
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Joseph Wherton
3 University of Plymouth, Plymouth, UK
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Richard Byng
3 University of Plymouth, Plymouth, UK
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Abstract

Background The Covid-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks in remote general practice

Aim To develop an empirically-based and theory-informed taxonomy of risks associated with remote consultations.

Design and setting Qualitative sub-study of data selected from the wider datasets of three large, multi-site, mixed-method studies of remote care in general practice prior to and during the Covid-19 pandemic in the UK

Method Semi-structured interviews and focus groups with a total of 176 clinicians, and 45 patients. We analysed data thematically, taking account of an existing framework of domains of clinical risk.

Results The Covid-19 pandemic brought changes to estates (eg, how waiting rooms were used), access pathways, technologies, and interpersonal interactions. Six domains of risk were evident in relation to[1] practice organisation and set-up (including digital inequalities of access, technology failure and reduced service efficiency); [2] communication and the therapeutic relationship (including a shift to more transactional consultations); [3] quality of clinical care (including missed diagnoses, safeguarding challenges, over-investigation and over-treatment); [4] increased burden on the patient (eg, to self-examine and navigate between services); [5] reduced opportunities for screening and managing the social determinants of health; and [6] workforce (including increased clinician stress and fewer opportunities for learning).

Conclusion Notwithstanding potential benefits, if remote consultations are to work safely, risks must be actively mitigated by measures that include digital inclusion strategies, enhanced safety-netting and training and support for staff.

  • remote consultations
  • clinical risk
  • general practice
  • family practice
  • telehealth
  • safeguarding
  • Received October 21, 2021.
  • Revision received January 5, 2022.
  • Accepted January 18, 2022.
  • Copyright © 2022, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Accepted Manuscript
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 Shaw, Joseph Wherton, Richard Byng
BJGP Open 29 April 2022; BJGPO.2021.0204. DOI: 10.3399/BJGPO.2021.0204

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Accepted Manuscript
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 Shaw, Joseph Wherton, Richard Byng
BJGP Open 29 April 2022; BJGPO.2021.0204. DOI: 10.3399/BJGPO.2021.0204
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Keywords

  • remote consultations
  • clinical risk
  • General practice
  • family practice
  • telehealth
  • safeguarding

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