Remote consultations

• Disengaged in own care: patients may not feel able to ask questions or raise concerns as easily as when in-person¹⁰

• Quality of follow-up: issues receiving supplementary information may occur (e.g., leaflets or emails not coming through)⁷

• Privacy concerns: patients may be concerned by the security and confidentiality of online systems³

• Access: there may be general confusion around how to get an appointment or the type of appointment they want, and uncertainty over the types of appointment available (e.g., video appointments are very rarely utilised)¹¹

• Technological concerns: interruption to the flow of conversation has been shown to impact consultation¹¹

• Lack of continuity of care: lack of communication and continuity of care in an already complex health system may impact health professionals’ ability to safety-net patients effectively and increase the risk of patients slipping through the net. This is referred to as the ‘Swiss Cheese Effect’⁴

• Poor integration of technology into current ways of working: very quick initial uptake of remote consultations means practices may need to redevelop workflows, due to lack of training, lack of organisation and availability of technology ^{12 13}

• Impacted clinical intuition: evidence suggests clinician gut feeling, as well as ‘doorknob disclosures’ from patients, are reduced in remote consultations, which are especially important when identifying non-specific cancer symptoms ^{14 15}

• Concern for patient groups with less access¹⁴

• Impact on health professionals: Research has shown that the shift to remote consultations can have a negative impact on health professionals’ mental health. This is due to the potential increase in workload via duplication¹⁰, anxiety around mistakes and liability without sufficient training for new ways of working and negative press about remote consultations⁹. For health professionals experiencing this, you can find access to help and support here.

Older patients^8161761819

• Research has shown that older patients can find it difficult to access online systems due to decreased health literacy or limited online access (e.g., no smartphone) and may therefore require support

• Limited trust with online systems may be a barrier to disclosing all relevant information in an appointment

• May have difficulty understanding or recalling advice provided online

• Unable to rely on body language cues and lip reading if the person has a hearing impairment

Poor health literacy³

• Research has shown patients are less likely to receive supplementary information (e.g., leaflets via email) compared to in person, which could have a greater impact on those with lower health literacy

• Research has also shown that some patients may feel less confident asking questions or taking an active role in their care in a remote consultation, potentially reducing health literacy

Less affluent / lower socioeconomic position¹¹¹⁶

• May not be able to afford the technology required for remote consultations (e.g., smart phones and laptops)

• May encounter issues with phone credit and Wi-Fi connection

Men¹⁷¹⁹

• Research suggests that women use remote consultations more than men. The reason for this is unknown but may be influenced by gender preferences and patterns of disease

Learning disabilities¹¹

• Research has shown that communication issues can occur via remote consultations

Poor IT literacy¹⁶

• For those who find technology more challenging to navigate, they can be put at a disadvantage when trying to access remote consultations and utilise the service effectively

The following highlights groups that can be advantaged or disadvantaged by remote consultations, depending on specific situations and this should be kept in mind by health professionals.

Those with mental health issues⁹¹⁶²⁰

• Can find remote appointments helpful if the person finds in social situations challenging

• Can find remote appointments distant and unsupportive

Those whose first language is not English^13161819

• Internet connection and lack of body language cues can be a disadvantage

• Research suggests the patient is more likely to communicate openly if the translator is remote rather than in person

Excluded groups e.g., travelling communities, homeless⁷

• Can improve continuity of care, as GP can access patient wherever they are

• Unlikely to keep up to date with changes in protocol in primary care

Visually, verbally, hearing impaired¹⁴²⁰¹⁵

• Written communicating e.g., e-consult and emails can be an easier way for this group to express themselves, but should not be used instead of providing support where a face-to-face or remote appointment is required

• Internet connection and lack of body language cues can be a barrier

Rural communities

• Easier access as no need to travel¹⁴

• Research shows concern around the risk that a two-tiered system could develop in rural areas if only online consultations are offered. This could potentially disadvantage those who already face barriers to access even further (e.g., those who are less affluent) ¹⁴