Fadila Ana-Maria Al Soodi is a UK GP passionate about improving access, continuity, and equity in general practice.
The pandemic pushed remote consultations from an innovation into a necessity. In many ways, they have improved access: patients no longer need to travel or take time off work for routine issues. Those with mobility problems, caring responsibilities, or anxiety have often found remote access liberating.¹,²
But convenience for some has come at a cost to others. Patients without reliable internet access, digital confidence, or English fluency face significant barriers.³ As general practice increasingly offers ‘digital-first’ models, it is vital we ask: who are we leaving behind?
Older adults, people with disabilities, and non-native speakers often struggle most with remote access.³,⁴ Even the seemingly simple act of completing an online triage form can feel overwhelming when unwell.⁵ Digital exclusion isn’t a niche issue; it is a major driver of inequality.³,⁶
Privacy is another hidden cost. The consulting room offers confidentiality by design; a remote call does not. Patients living in shared housing, unstable relationships, or unsafe environments may find it difficult—or impossible—to discuss sensitive issues.⁷ Younger patients, in particular, tell us that finding a private space for a mental health conversation can be a major hurdle.⁸
Remote consulting also changes the dynamic of the doctor–patient relationship. Telephone consultations lack non-verbal cues; video can restore some, but not all, of this subtle communication.²,⁹ Some patients appreciate the speed and simplicity, especially for straightforward problems.¹² But others find it harder to feel heard, harder to build trust, and harder to explain complex or emotional concerns.⁹
Relational continuity—a cornerstone of general practice—risks being diluted.¹⁰ When patients cannot easily choose their GP, or feel forced to navigate unfamiliar digital systems, care fragments.⁶
Patients should be able to select the consultation mode that suits their clinical needs and personal circumstances.
Clinical safety is another concern. Some conditions—a rash, an injured joint, a worrying lump—simply cannot be adequately assessed at a distance.⁹ Patients worry about being ‘fobbed off’ or about delayed diagnoses.⁶ Robust safety-netting and a low threshold for face-to-face review are essential.⁶
So what can we do?
Choice should be the starting point. Patients should be able to select the consultation mode that suits their clinical needs and personal circumstances.⁶ Remote consultations should be an option, not a gateway. Clear information—available in multiple languages—must explain how patients can and should access care.³
Continuity must remain a priority, not an afterthought. Seeing the same GP, even remotely, can help maintain trust and understanding.¹⁰ Where this is not possible, practices should consider how to foster team-based continuity.⁶
Flexibility is vital. Not every problem suits a phone call. Not every patient can navigate an app. Offering blended models—face-to-face, telephone, video, and online messaging—keeps services accessible and patient-centred.² ⁶
And we must tackle digital exclusion head-on. Practices and policymakers must invest in digital literacy support, provide clear alternatives to online systems, and design services that don’t assume every patient has a smartphone or broadband.³ ⁴
Remote consultations are here to stay. They can be a powerful tool for improving access and efficiency—but only if we remain focused on patients’ needs, not just the system’s convenience. Listening to patients’ experiences—good and bad—is our best guide.⁸ If we get it right, remote consultations can form part of a more humane, equitable, and responsive general practice. If we get it wrong, we risk deepening the inequalities we have spent decades trying to narrow.
References
- Greenhalgh T et al. Virtual consultations for Covid-19. BMJ. 2020;368:m998.
- Donaghy E et al. Acceptability, benefits, and challenges of video consulting in general practice. BJGP. 2019;69(686):e586-e594.
- O’Connor S et al. Understanding the factors influencing remote consultations. BMJ Open. 2021;11:e043279.
- Armitage R, Nellums LB. COVID-19 and the digital divide. Lancet Public Health. 2020;5(8):e425.
- NHS Digital. Making digital health inclusive. 2022.
- Bakhai M et al. Remote care and digital-first primary care. NHS England. 2021.
- Shaw S et al. Addressing the privacy challenges of remote consulting. BMJ. 2020;371:m3945.
- Boldrini T et al. Psychological support and privacy in telemedicine: a systematic review. J Telemed Telecare. 2020;26(6):319-335.
- Hammersley V et al. Comparing video, telephone and face-to-face consultations. BJGP. 2019;69(686):e595-e604.
- Freeman G, Hughes J. Continuity of care and the patient experience. The King’s Fund. 2010.
Featured Photo by Mohammadreza alidoost on Unsplash
