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‘Urgent’ need to restore public trust in remote consultations, warns study

by Awil Mohamoud
9 December 2020

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There is an ‘urgent’ need to restore public trust in general practice, and remote consulting in particular, following months of ‘negative’ media coverage, a report published in the British Journal of General Practice (BJGP) has warned.

Researchers analysed the portrayal of general practice in the national newspapers in the early stages of the Covid-19 pandemic (between March and May) and compared it to coverage as the first national lockdown was lifted (between July and August).  

The report found that newspapers covered remote consulting widely, and at the start of Covid, depicted it ‘positively’, as they equated the digital change with ‘progress’ – linking it with improved efficiency and safety. 

However, between July and August, the narrative changed, it found, with articles questioning the ‘persistence’ of a remote-first service. These instead emphasised, for example, missed diagnoses, challenges to the therapeutic relationship and digital inequalities. 

Improving the perception

The report said perceptions about remote consulting could be improved, with further clarification as to ‘what kind of clinical consultations with what kind of patient are suited to what kind of medium’.

In July, Matt Hancock, health secretary, told GPs to make remote consultations the default option unless there’s a ‘compelling clinical reason’ not to, adding that he believes that ‘Zoom medicine’ is key to moving forward after the pandemic. 

Responding to the statements at the time, Dr Richard Vautrey, BMA GP committee chair, warned of the need to continue ‘triage arrangements’ and use remote consultations ‘where appropriate’ for staff and patient safety. 

The researchers recommended that the ‘wide menu’ of consulting options available now in general practice be provided ‘flexibly and with sensitivity to patients’ needs and preferences’ – rather than any medium being imposed ‘by default’. 

The latest NHS Digital data for appointments shows 60% of appointments in general practice took place face-to-face in October, with 35% over the phone, and just 0.49% through video or online. By comparison, in May, 47% of consultations were conducted face-to-face and 48% by telephone. 

The report said: ‘The kind of consultation offered should be decided on the basis of what is best for the patient – and where possible, this should be a shared decision.’

The report also called for measures to ensure safety – such as better guidance, standards and training – and avoid inequity, by ‘making face-to-face appointments clearly available and accessible to all for whom remote consultations are unacceptable or inappropriate’.

Change in media reaction

The researchers said the initial press reaction to remote consultations occurred at a time when its mass adoption in general practice coincided with policies ‘in step’ with wider measures, such as those encouraging physical distancing and remote working. 

However, it added the latter reaction, which was more negative, took place when the policy ‘had abruptly become out of step with wider infection control measures’.

In the early stages of Covid, GPs were reported as viewing the move as ‘sensible’, with mentions about improved safety, the ability for self-isolating GPs to work from home, and convenience, the study found.  

Though concerns, such as those about missed symptoms and diagnoses and barriers to access, were reported on, ‘the trade-off was depicted as worthwhile, with benefits discussed more frequently and emphatically’, the researchers added.

Between July and August, the trade-offs were ‘viewed differently’, they said, with some of those issues covered in ‘more detail’ and with ‘additional examples’. 

The report also found that ‘military metaphors’ were evident in the early phase of the pandemic, with one article, for example, entitled ‘GPs told to switch to digital consultations to combat Covid-19’. 

The researchers said they found no military metaphors used in the articles, collected in the research, between July and August, ‘suggesting that the media considered the ‘war’ against Covid-19 to be over’.