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Impact of digital technology on practice nurse workload may be ‘modest and gradual’

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Offering primary care appointments by telephone and via online technology will not work unless practice nurses, GPs and other staff receive better training, according to new research.

NHS policy encourages GP surgeries to introduce alternatives to face-to-face consultations, in order to increase access to healthcare and cut GPs’ workloads.

“Practice policies must be developed carefully, agreed by all in the practice”

Kamila Hawthorne

But a study led by staff at the University of Bristol that looked at eight GP surgeries’ attempts to use new technology to replace face-to-face consultations found little evidence it was working.

In total, 45 staff members were interviewed, including 19 GPs, one practice co-ordinator, one nurse practitioner and five practice nurses.

The research especially highlighted insufficient training of non-clinical staff, such as receptionists, on how to use the technology or explain its benefits to patients.

Overall, researchers concluded that surgeries were often responding to incentives to “go digital” without clearly thinking through the likely costs and benefits for patients and practice staff.

Colleagues were often unaware of each other’s practice, noted the study. For example, members of the practice team did not always know whether others were in email contact with their patients.

“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,” said the study authors.

“Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team,” they stated.

“Implementation was not well enough thought through in relation to personnel, training or logistical factors”

Chris Salisbury

Senior study author Professor Chris Salisbury, from the University of Bristol’s Centre for Academic Primary Care, said surgeries were having difficulty implementing such new approaches.

“Our study shows that, currently, GP practices are struggling to identify and implement the most beneficial uses of these new technologies and they are frequently being adopted without sufficient understanding or support,” he said.

“Implementation was not well enough thought through in relation to personnel, training or logistical factors,” he said. “As a result, efficiencies are not being realised.”

Rather than decreasing GP workloads, the new approaches were often adding to their work, warned Professor Salisbury.

Lead study author Dr Helen Atherton, from the University of Warwick, said: “The availability of a wider range of options for consulting could be very helpful for some patient groups.

However, she noted that it also had the “potential to reduce the time” the clinician had available for face-to-face consultations, which “could disadvantage other patients”.

She said that the “top-down” approach, offering financial incentives to surgeries to adopt new consultation methods was not the most effective approach to ensuring fair access to care.

The Royal College of GPs welcomed the research, which was funded by the National Institute for Health Research and published today in the British Journal of General Practice.

“Many GP practices are already offering online consultations in some form,” said RCGP vice chair Professor Kamila Hawthorne. “However, we also know – and this research backs this up – that they don’t necessarily help to… improve access to general practice services for patients.” 

Online and telephone consultations were “great” for some patients but not suitable for others, and the RCGP would be developing guidance on the subject, noted Dr Hawthorne.

“If this route to consulting with patients is being considered by a practice, practice policies must be developed carefully, agreed by all in the practice, and followed to ensure patient safety,” she added.

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