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This study aims to define good practice and inform its implementation in relation to clinician-patient consultations via Skype and similar virtual media.

Why is this important?

Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. There are a number of video communication tools available, such as Skype, that offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (e.g. they may be more cost-effective). But fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they bring significant technical, logistical and regulatory challenges.

We need to know whether the dynamic in the consultation will change if carried out via video-based communication tools, as opposed to in office, and what variables may mediate that change. We also need to understand how such tools influence and relate to organisational systems and processes so that they can be appropriately embedded and sustained within routine care practice.


To explore the advantages and limitations of video consultations, we are conducting in-depth qualitative studies of real consultations ('micro' level) embedded in an organisational case study ('meso' level), taking account of national context ('macro' level). The study is based in two contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK.

At the micro level, we are studying the clinician and patient interaction during Skype consultations. Up to 45 consultations will be recorded using a digital camcorder and screen capture software to record actions, talk and screen images showing on each party's computer. We will interview participants to capture their experience prior to, and reflections following, the consultation.

At the meso level, we are mapping the administrative and clinical processes that will need to change to implement and support online consultations. Data will be collected through interviews and observations of work practices, documents, charts and other artefacts supplied by staff.

At the macro level, we are conducting interviews with national stakeholders to understand the national-level context for the introduction of virtual consultations in NHS organisations, and what measures might incentivise and make these easier.

The project also includes an action research component, in which we will work with local senior managers and commissioners to understand and implement the organisational change required to support the use of virtual consultations.


There is great potential for the use of video-based communication tools, such as Skype, for remote consultations between patient and clinician. This could improve patients’ access to healthcare professionals, and increase their levels of engagement and confidence to manage health conditions.

We plan to inform the implementation of good practice in relation to clinical consultations via Skype and other similar virtual media. The study will provide guidance for NHS staff on effective virtual consulting, as well as operational guidance to support the implementation of such technology within clinical settings.

Next steps:

Are you interested in finding out more about VOCAL? Do you have an interest in using or supporting the use of virtual media for clinical consultations? If you would like more information about the study, contact Joanne Morris (Project Manager).

Research team:

Further information:

Full project title:
VOCAL: Virtual Online Consultations - Advantages and Limitations: A qualitative study of micro, meso and macro level interactions.

Length of project:
March 2015 – February 2017 






External collaborators:

Queen Mary University of London, UK:

  • Emma Byrne, Research Fellow, Barts and the London School of Medicine and Dentistry, London

Barts Health NHS Trust, London, UK:

  • Shanti Vijayaraghavan, Consultant Diabetologist
  • Satya Bhattacharya, Consultant Surgeon
  • Desirée Campbell-Richards, Research Nurse
  • Charles Gutteridge, Consultant Haematologist and Clinical Information Officer
  • Philippa Hanson, Consultant in Diabetes and Endocrinology
  • Anna Collard, Research Consultant
  • Joanne Morris, Project Manager
  • Seendy Ramoutar, Clinical Nurse Specialist

Tower Hamlets Clinical Commissioning Group, London, UK:

  • Isabel Hodkinson, Principal Clinical Lead


DREAMS Study: Diabetes Review, Engagement and Management via Skype
VOCAL Project Website


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