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Alternatives to the face-to-face consultation in general practice: Focused ethnographic case study

Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris


Helen Atherton

Heather Brant

Sue Ziebland

Annemieke Bikker

John Campbell

Andy Gibson
Associate Professor in Patient and Public Involve

Brian McKinstry

Tania Porqueddu

Chris Salisbury


© British Journal of General Practice. Background NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. Aim To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Design and setting Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Method Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report. Results Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-toface consultation as the ideal. Conclusion Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.


Atherton, H., Brant, H., Ziebland, S., Bikker, A., Campbell, J., Gibson, A., …Salisbury, C. (2018). Alternatives to the face-to-face consultation in general practice: Focused ethnographic case study. British Journal of General Practice, 68(669), e293-e300.

Journal Article Type Article
Acceptance Date Jan 29, 2018
Online Publication Date Mar 28, 2018
Publication Date Apr 1, 2018
Deposit Date Feb 20, 2018
Publicly Available Date Feb 20, 2018
Journal British Journal of General Practice
Print ISSN 0960-1643
Electronic ISSN 1478-5242
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Volume 68
Issue 669
Pages e293-e300
Keywords communication, electronic mail, ethnography,
general practice, qualitative research, remote
consultation, workload
Public URL
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