Title: The potential of alternatives to face to face consultation in general practice and the impact on different patient groups
Funder: Department of Health (England)

Abstract: AIM: This study uses a theory based evaluation approach to understand how under what conditions for which patients and in what ways alternatives to face to face (F2F) consultations such as use of the telephone email or internet video may offer benefits to patients and practitioners in general practice. We will develop recommendations & a web-resource for practices about how to implement the most promising alternatives and model the best methodological approach for evaluation.This covers the first stages of the MRC complex intervention framework:IDENTIFYING EVIDENCE BASE: We will conduct a synthesis of qualitative and quantitative research on patients’ and practitioners’ experiences of alternatives to F2F consultations with a particular focus on the views of different groups of patients and on factors that promote or hinder the wider implementation/uptake of alternative forms of consultation.DEVELOPING THEORY: The study uses a mixed methods case study design. Using a scoping exercise we will identify the range of ways in which general practices in England & Scotland are currently providing alternatives to F2F consultations and identify approx. 8 practices with varied experience of implementing these alternatives to act as case studies.In each case study practice we will interview clinicians and practice staff to understand the alternatives to F2F consultations that have been tried why and how these were introduced key contextual factors barriers and facilitators to implementation and intended benefits for patients clinicians and/or practices. We will explore assumptions about how the alternative forms of contact might lead to benefits. We will interview patients to explore advantages/disadvantages of alternatives to F2F consultation and how different forms of communication impact on the consultation and the clinician-patient dynamic. We will purposively select patients with different characteristics (e.g. age deprivation long term conditions). A key focus will be the impact of alternative forms of access on different patient groups and whether they increase or reduce access inequalities. We will observe how practices record details of consultations not delivered F2F and if possible use routine data to quantify this including the number of patients using these alternatives how this has changed over time and take-up by different patient groups.MODELLING PROCESS & OUTCOMES: Based on our findings we will develop recommendations and a web-resource for general practices about the most promising applications of alternatives to F2F consultations for different patient groups for different purposes and in different practice contexts. These recommendations will be developed by the research team and optimised & validated at a workshop involving patients GPs and other stakeholders. Treating use of these recommendations as an intervention we will use our findings within a theory based evaluation approach to model the key contextual factors processes and outcome measures that need to be assessed in any subsequent evaluation. Data from the case studies will be used to address questions about the feasibility and best methodological approach to evaluation including the extent to which the intervention can be standardised feasibility in different types of practice which alternatives to F2F consultations to offer the number of patients who are likely to use them for which purposes and consultation rates.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE