Clinical risk in remote consultations in general practice: findings from in-Covid-19 pandemic qualitative research

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>The Covid-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks in remote general practice</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To develop an empirically-based and theory-informed taxonomy of risks associated with remote consultations.</jats:p></jats:sec><jats:sec><jats:title>Design and setting</jats:title><jats:p>Qualitative sub-study of data selected from the wider datasets of three large, multi-site, mixed-method studies of remote care in general practice prior to and during the Covid-19 pandemic in the UK</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Semi-structured interviews and focus groups with a total of 176 clinicians, and 45 patients. We analysed data thematically, taking account of an existing framework of domains of clinical risk.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The Covid-19 pandemic brought changes to estates (eg, how waiting rooms were used), access pathways, technologies, and interpersonal interactions. Six domains of risk were evident in relation to[1] practice organisation and set-up (including digital inequalities of access, technology failure and reduced service efficiency); [2] communication and the therapeutic relationship (including a shift to more transactional consultations); [3] quality of clinical care (including missed diagnoses, safeguarding challenges, over-investigation and over-treatment); [4] increased burden on the patient (eg, to self-examine and navigate between services); [5] reduced opportunities for screening and managing the social determinants of health; and [6] workforce (including increased clinician stress and fewer opportunities for learning).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Notwithstanding potential benefits, if remote consultations are to work safely, risks must be actively mitigated by measures that include digital inclusion strategies, enhanced safety-netting and training and support for staff.</jats:p></jats:sec>