Mode of Consultation in General Practice (ModCons)
ModCons is a sub-study of the wider project, Remote by Default 2: the “new normal”? This project seeks to inform high-quality, safe and equitable care in UK general practice in the context of policies which require phone, video or e-consultation ‘by default’. The ModCons study zooms in on decision-making about who gets what kind of care in this context. Our aim is to understand how, when, by whom and why decisions are made to offer these different types of appointment, and to consider the implications for the future organisation and delivery of general.
Why is this important
The shift to remote consulting in UK general practice, using phone and video to help with infection control during the COVID-19 pandemic will have lasting impact on how primary care services are provided to patients and the public. Remote consulting has been the default throughout the pandemic, but there have been wide variations between practices in terms of how care is provided and how patients can access care. Some patients have continued to consult in person. This mix of in-person and remote consulting is likely to continue long term. At the moment, we don’t know how decisions are made about which sort of consulting to use, and how to best organise and deliver these different types of appointment in general practice.
We are working with three practices to collect detailed data about consulting, using a range of research methods, which are predominantly qualitative. We are:
- Carrying out intensive ethnographic observations in each GP practice for two week-long periods, shadowing both GPs and other members of the primary care team to gain first hand insights into the work they do and the decisions they make about consulting
- Interviewing practice staff (e.g. receptionists, GPs, practice nurses) to understand their experience of remote consulting and their role in shaping decisions about the type of appointment offered
- Homing in on ten patients with ‘complex needs’ in each practice (30 in total) and tracking their consulting activity over the previous 24 months to understand their use of different types of consultation and how and why this might change over time
- Collecting and analysing routine practice data to understand the levels of use of the different modes of consulting across each practice.
We are involving patients and the public in the design and conduct of the research via the study advisory group for RbD2, and engaging with PPI representatives to inform the research, discuss emerging findings and eventually produce a patient-led paper about experiences of different consultation modalities. We are working with Design Science to co-produce a patient animation resource for navigating multi-modal primary healthcare.
This project is funded by the National Institute for Health Research