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

Background: 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.Design & setting: Qualitative sub- study of data selected from the wider datasets of three large, multi- site, mixed- method studies of remote care in general practice before and during the COVID- 19 pandemic in the UK.Method: Semi- structured interviews and focus groups, with a total of 176 clinicians and 43 patients. Data were analysed thematically, taking account of an existing framework of domains of clinical risk.Results: The COVID- 19 pandemic brought changes to estates (for example, how waiting rooms were used), access pathways, technologies, and interpersonal interactions. Six domains of risk were evident in relation to the following: (1) practice set- up and organisation (including digital inequalities of access, technology failure, and reduced service efficiency); (2) communication and the clinical 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 (for example, 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).Conclusion: 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.

Automated summary

This study develops a taxonomy of risks associated with remote consultations in general practice based on qualitative sub-study data. The COVID-19 pandemic has brought changes and risks to various aspects of remote consultations, including practice set-up and organization, communication and the clinical relationship, quality of clinical care, increased burden on patients, reduced opportunities for screening and managing social determinants of health, and workforce. Mitigating these risks requires actively implementing measures such as digital inclusion strategies, enhanced safety-netting, and training and support for staff.