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