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

Rebecca Rosen, Sietse Wieringa, Trisha Greenhalgh, Claudia Leone, Sarah Rybczynska-Bunt, Gemma Hughes, Lucy Moore, Sara E Shaw, Joseph Wherton, Richard Byng

The Covid-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks in remote general practice AIM: To develop an empirically-based and theory-informed taxonomy of risks associated with remote consultations. 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 METHOD: 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. 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). 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.