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6 September 2021
Personalised care, which aims to give people more say in their healthcare, and Digital First Primary Care, a move towards remote consulting, are both important NHS England policies, but they can be in tension. A new report aims to explore this tension and understand how remote consulting could be best set up to support personalised care. The report was commissioned by the NHS Personalised Care Institute and was conducted by researchers from the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) and the Centre for Academic Primary Care (CAPC) at the University of Bristol.
Personalised care is when healthcare decisions and future care and support plans are made jointly by people receiving care and their health professionals. The care plan is shaped by what matters most to the person and their individual situation. This process works best when there is a relationship of trust and the health professional has a good understanding of the person’s situation.
Remote consultations are when the healthcare professional and the patient are not in the same room. In primary care, Digital First means that appointments are booked online or healthcare requests are responded to after the patient completes an online form. Remote consultation, especially by telephone, has become common during the coronavirus pandemic.
Before this change becomes permanent, it is important to consider its effects on the quality of and access to care. This includes how personalised care might be affected if patients are not able to see their doctor or nurse face-to-face when they wish.
The researchers aimed to answer the following questions:
They conducted a rapid review of evidence on remote consulting. They found over 1,100 studies published over the last 20 years, then considered the implications of the findings for delivering personalised care to different people via remote consultations.
They found that remote consultations are not inherently good or bad and may benefit some people for some situations but disadvantage others. Although in general, digital consultation is used more by younger, more affluent people, there are many other characteristics that affect what patients prefer. Many older people are happy to use telephone or email.
In general, remote consultations focus on one problem only. They are better for simple problems and easier when the health professional and patient already know each other. To use them successfully for personalised care, health professionals need to consider carefully when to use them and for what purposes, and allow patients a choice about how they access care.
Good preparation and planning can help healthcare organisations avoid unintended consequences such as reducing the quality of care or disadvantaging some people, for example those who don’t have access to the internet or who have complex needs. Making assumptions about what patients would prefer or arranging services to suit the practice could further deepen the health inequalities often experienced by people with multiple or complex health conditions.
Personalised care is recognised as the best way to provide care for people with long-term conditions and complex needs. It can support them to maintain the best quality of life possible with their health conditions. The in-depth conversation needed for this is difficult to achieve in a remote consultation if the health professional does not already know the person well. Additional training in using remote consultations may be helpful.
Cindy Mann, Research Fellow at the Centre for Academic Primary Care, said:
“Our research showed that remote means of consulting are not inherently good or bad for personalised care. Whatever means are used may be helpful for some people and situations, but difficult for others. So there has to be flexibility for patients to choose what will work best for them. Health professionals need to be trained to know when and how to make best use of video and telephone consultations.”
Pauline Foreman, Clinical Director, Personalised Care Institute, said:
“We are delighted with the report which highlights key priorities for the future implementation of remote consultations to support the delivery of personalised care. This includes training for all healthcare professionals in the enhanced communication skills required to develop relationships and maximise engagement in the remote environment. The Personalised Care Institute will be developing training resources to support all healthcare professionals to develop and refine these skills.”
The impact of remote consultations on personalised care: evidence briefing (PDF)
Cindy Mann, Andrew Turner, Chris Salisbury
This report was commissioned and paid for by the NHS Personalised Care Institute and supported by NIHR ARC West, in partnership with the Centre for Academic Primary Care at the University of Bristol.