Before introducing an alternative to a face-to-face consultation then you may wish to think about the following:

Getting it “right” is dependent on your rationale for using an alternative to a face-to-face consultation? Is it for convenience for patients, improved patient access or to manage demand? It is also dependent on ensuring that the alternative to a face-to-face consultation(s) you have decided to introduce are suitable for your practice and its demographics. Click for links to Who is it for? and For what purpose?

Successful Introduction

Getting it “right” is also dependant on your practice staff being aware of this rationale and the purpose of the introduction of an alternative to a face-to-face consultation. This might be dependent on who is driving the use of an alternative to a face-to-face consultation, whether it is a practice wide or a ‘lone wolf’ decision, or is it a decision based outside the practice such as from the local Clinical Commissioning Group (CCG)/health board or via funding. Be cautious about thinking that the reason for the introduction of an alternative to a face-to-face consultation might be obvious to all the staff and assuming that all they are all on-board, plus consider that the introduction of an alternative to a face-to-face consultation has a wider impact than just on the practitioners using it.

To ensure that you get an alternative to a face-to-face consultation “right” all the staff members’ roles, attitudes and beliefs must be considered. For instance, who decides on whether a consultation is face-to-face or via an alternative to a face-to-face consultation and at what point in the patient journey might this be reasonable? Do the patients have a free choice of what sort of consultation they would like? Or does the practice try to channel the patients in to using a particular form of contact? How are consultations arranged – by the patient, by the clinician or by the reception staff?

It is important not to underestimate the importance of ensuring that all the staff are clear about why this is being introduced and their role in the introduction including the administrative and reception staff. Patients need to be aware of the offer of an alternative to a face-to-face consultation and the reception staff are key to ensuring that patients are informed and that alternatives are offered to patients seeking an appointment. This communication needs to continue throughout the life of an alternative to a face-to-face consultation as often as the use is adapted, and new issues may arise. This may be best managed through a staff meeting but other options are possible, as long as the staff members have an opportunity to ask questions and are invited to share their comments. Without this there is a risk that the alternative to a face-to-face consultation is not promoted or used by patients, and there could be a detrimental impact on the staff. It is important to think about how the expectations of all parties will be managed.

A way of ensuring that there is practice wide adoption of the alternative to a face-to-face consultation is to agree rules of engagement, discuss these widely and create protocols. This will provide guidance for all the staff and may also indicate areas where there may be extra workload.

Impact on Staff

The impact on staff was often related to their level of input in the introduction of alt-con. The positives were mainly for GPs who reported that the use of an alternative to a face-to-face consultation could lead to flexible working resulting in an ability to manage their own workload thereby having a level of control which improved Job satisfaction and sense of professional identity. For the practitioners, some may feel more comfortable using the alternative to a face-to-face consultation than others who might require more training or time to adjust. Some may feel resistant to adapting whereas others may be innovators within the practice.

For other practice staff, such as the reception and administrative staff, the introduction of an alternative to a face-to-face consultation could lead to issues of conflict within their role. However, since this happens in specific work areas it may not be apparent to other staff members. There is a need to encourage discussions within staff teams.

There have been some concerns that the use of an alternative to a face-to-face consultation will diminish valued aspects of primary care such as the relationship and continuity of care. However, findings from our study indicated that although some aspects can be lost, such as non-verbal cues, it was still possible to maintain a relationship, it enhanced continuity of care and as a result often increased the feeling of professional satisfaction.

Effect on Workload

There may be an increase in workload as a result of using an alternative to a face-to-face consultation. The reception and administration staff may have to make decisions about what, when and who to offer an alternative to a face-to-face consultation, to identify that it is being offered as an alternative to a face-to-face consultation appointment, and to manage patient expectations etc. They may also be involved in to manage a process of filtering requests for e-consultations and for incorporating consultation records within the patient records.

Many forms of an alternative to a face-to-face consultation can lead to hidden work unless a clear record of what is done is made. It is therefore essential that alternatives are scheduled into existing practice. We observed emails and phone calls being done during breaks and before or after the usual clinic times therefore leading to extra work that wasn’t being accounted for. In addition, the recording of an alternative to a face-to-face consultation can be problematic, particularly if it is seen as a quick patient follow-up, responding to a patient request or a simple piece of administrative work, therefore it is crucial that the practice agrees a method of acknowledging and recording these encounters.

Recording all consultations systematically will also enable you to audit whether an alternative to a face-to-face consultation has achieved your here objectives For further information on how will we know it has worked click here. In addition, if the alternative to a face-to-face consultation is not integrated into the current system this can lead to additional work for staff, it is therefore worth thinking about how the consultation can be incorporated into the patient record.

Additional Costs

The introduction of an alternative to a face-to-face consultation might require additional training so have you considered the cost of providing training and the time that you may need to cover staff who are receiving the training?

Safety and Security

One of the concerns often heard about the use of an alternative to a face-to-face consultation is the issues of safety and security. It is important that information and clinical governance are considered and that the practice follows guidelines. It is also crucial that systems are in place for the secure storage of emails, audio or digital files relating to an alternative to a face-to-face consultation. We have provided some useful guidance below:

• NHSmail: a secure email service approved by the Department of Health for sharing patient identifiable and sensitive information
• Academy of Medical Royal Colleges – i-care: Information, Communication and Technology in the NHS
• Academy of Medical Royal Colleges – Ehealth Competency Framework
• GMC guidance on – Prescribing Guidance: Remote Prescribing via Telephone, Video-link or Online
• Email Consultations in Healthcare
• Health and Social Care Information Centre
• Medical Protection – Risk alert: Technology in general practice
• RCGP – Health Informatics Group