Abstract
Background: The rapid introduction of remote consulting to the UK in 2020 has resulted in new risks to quality and safety. I investigated the consequences for quality and safety from this phenomenon.Methods: These issues were explored over a 4-year period in a multi-method qualitative study. This included document analysis, interviews and workshops combined with secondary analysis of data from observations in 12 practices.
Results: are presented through 5 different research papers. These highlight the consequences for quality and safety that arise from the remote provision of British general practice. They demonstrate that the provision of quality care is difficult in contemporary general practice. This is partly due to external factors such as austerity and the complexity of the illnesses now treated in primary care. These are further compounded by social changes resulting in a decrease in informal support networks and inadequate physical and digital infrastructure. Such challenges are often compounded by new inefficiencies introduced by digitalisation, with knock on consequences for the human-based elements of care. Safety can be compromised when systems have not adequately adapted for the provision of remote primary care, or when inappropriate patients and conditions are managed remotely. The UK print based media has been particularly active in highlighting such patient harm.
Remote consulting can be appropriate for a wide range of conditions, especially when combined with video. Patients with co-morbidities, conditions which are not resolving following remote consultation or who present with conditions such as chest pain may be less suitable for remote consultation. Delivering remote care requires an enhanced skill set for all team members. An evidence-based set of competencies is presented, alongside suggestions for enhancing current training provision for practice teams.
Conclusion: Consequences for quality and safety have arisen from the remote provision of care in British general practice. It is challenging to provide high quality care in contemporary general practice. Understanding which patients will benefit from remote care, where the safety risks lie and putting in place appropriate training is vital.
| Date of Award | 8 Jan 2025 |
|---|---|
| Original language | English |
| Supervisor | Lorelei Jones (Supervisor) & Clare Wilkinson (Supervisor) |
Keywords
- general practice
- telehealth
- quality
- safety