| 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
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| 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
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| 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
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| 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
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| 5. Population and public healthPreventive care, screening; societal and family aspects of health and illness |
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| 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
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