Scottish Social Attitudes Survey 2021/22: public views of telephone and video appointments in general practice

1. Summary

1.1 Summary of the context

This report will present findings from the Scottish Social Attitudes (SSA) Survey 2021/22 about public attitudes towards remote appointments in general practices, specifically in relation to doctors (GPs) and nurses.

Prior to the COVID-19 pandemic, Scotland aimed to increase accessibility to health and social care via remote services including phone and video appointments. Both phone and video appointments were primarily used in secondary care settings and telephone appointments were commonly used in general practices, although were not the default mode. The 2019/2020 Health and Care Experience Survey reported that 87% of respondents had a face-to-face appointment in comparison to 11% having a phone appointment and less than 1% for video or e-mail. In response to the COVID-19 pandemic, the use of remote services accelerated across Scottish health care settings. This was primarily to reduce the risk of infection that was increased through face-to-face contact. General practices across Scotland offered patients remote appointments, with face-to-face appointments when necessary. As restrictions eased, phone and some face-to-face consultations generally remained the two main appointment methods in general practices. Due to the public's exposure to digital services, sped up by the pandemic, work was commissioned to understand general attitudes to and impacts of remote appointments.

Questions were commissioned by the Scottish Government and developed in partnership with The Scottish Centre for Social Research (ScotCen) to be included in the 2021/2022 Scottish Social Attitudes Survey (SSA). The research took place between October 2021 and March 2022. Respondents were selected through a probability sampling technique using the Postcode Address File (PAF) and stratified to represent rural areas and the most deprived areas more fairly. Overall, 1,130 people took part via telephone interview. ScotCen shared the results along with statistically significant findings of the survey with the Scottish Government Healthcare and Workforce Analytical Unit. Further information can be found in the Methodology section of this report.

People in Scotland were asked questions based on the four general themes (see Figure 1).

1.2 Summary of results

Results are presented under the four research themes (Figure 1). All results below are based on the significant differences found in the survey results.

1.2.1 How comfortable are people with accessing healthcare by video/phone compared with face-to-face?

• A higher percentage of people thought that they would be more comfortable with a face-to-face (94% very or fairly comfortable) appointment thanF a remote appointment (71% for phone and 67% for video).
• Those aged over 65 were more likely be very comfortable with face-to-face appointments (86%) in comparison to other age groups.
• Males (73%) were more likely to say they would be 'very/fairly' comfortable with video appointments than females (62%).
• Those with higher satisfaction with the NHS were 'very/fairly' comfortable with remote appointments (84% for phone and 79% for video). Lower levels of satisfaction with the NHS were linked with feeling uncomfortable with remote appointments.
• Those who reported using the internet several times a day were the most likely to be 'very/fairly' comfortable talking to their doctor or nurse via remote appointments (75% for phone and 71% for video).
• People with self-reported very good or good general health were more likely to be very comfortable with phone (40% vs 27% fair health vs 28% bad/very bad health) and video (40% vs 26% fair vs 13% bad/very bad) appointments than those with poorer health.

1.2.2 How easy are different types of appointments for patients?

• A higher percentage of the public thought that talking to a doctor or nurse via phone (81%) was easier than face-to-face (73%) and/or video (58%).
• People with self-reported very good or good general health were more likely to say attending face-to-face (53%), phone (53%), or video (36%) appointments would be very easy compared to those with bad/very bad general health (21% face to face, 36% phone, 16% video).
• Those without long term illnesses, health problems or disabilities were more likely to say that it would be very easy attending an in-person (51%) appointment and very/fairly easy attending a video (63%) appointment in comparison to those with long-term illnesses. No significant differences were found for ease of phone appointment preference across different health states.
• Higher satisfaction with the NHS was also linked to finding both in-person (88%) and remote appointments (92% for phone and 70% for video) 'very/fairly' easy. Lower levels of satisfaction with the NHS were linked with finding all three consultation modes difficult.
• Those who used the internet several times a day were the most likely to say that it would be 'very/fairly' easy to talk to their doctor or nurse via phone (84%) or video (61%) about a medical problem.

1.2.3 What impacts a person's decision to accept a remote appointment?

• The two biggest concerns for choosing to accept a remote appointment over face-to-face were how worried someone was about their condition (46%) and how quickly someone could get an appointment (36%).
• How easily someone could get to an appointment (7%) or how well someone knew the doctor they would be speaking to (7%) were lower priorities.

1.2.4 Thoughts towards more use in general practice of remote consultations in place of face-to-face?

• When asked about thoughts towards the use of remote consultations in place of face-to-face, over half of people strongly agreed/agreed that replacing face-to-face appointments with remote appointments would
  • result in their doctor knowing their patients less well (66%)
  • ensure that those who needed a face-to-face appointment could get one quickly (63%)
  • be more convenient for most patients (52%).
• There were mixed views as to whether remote appointments reduced the risk that serious medical conditions would be missed (40% for agree strongly/agree and 36% for disagree strongly/disagree).
• People with self-reported bad or very bad general health were more likely to agree that increasing remote appointments would result in their doctor knowing them less well (49%).
• Those with children under 16 viewed remote appointments comparatively more positively than those without children under 16, 26% (compared 14% of those without children under 16) found remote appointments more convenient than face to face appointments.

Significant differences in attitude were not found between individuals with different education (measured by Highest Level of Educational Qualification) or deprivation (measured by Scottish Index of Multiple Deprivation (SIMD)^[2]) levels, although may potentially be influential in patients' experiences of general practice appointments. There may also be evidence in existing research to suggest links between appointment type and respondent characteristics or demographics (e.g. general health and age linked to phone appointments), however this was not explored in this report

1.3 Summary conclusion

This survey highlights the diverse attitudes towards accessing general practice appointments remotely. Attitudes towards appointment type were influenced by whether the person would find different appointment types 'easy' or not and whether they would be comfortable with different appointment types. Video appointments in general practices seemed to be the least favoured option for the people of this survey. This has also been found in other surveys conducted with clinical staff in general practices. Equally variations in demographics or other factors may influence people's preferences and concerns. For example, good general health, frequent internet use, and high satisfaction with the NHS were linked to a more positive response across all three modes of appointments. Therefore, the needs of the patient, clinical judgement, and service efficiency/effectiveness should be central to ensuring that digital and remote appointments are enhancing patient care and safety.

Further research would be required to:

• understand the experiences people had with appointments, perhaps with a focus on capturing qualitative evidence
• widen the scope to include appointments with other members of the multidisciplinary team or other health and social care settings
• understand if the patient's reason for needing a health care appointment impacts the type of appointment preferred
• encourage wider participation from harder to reach groups that may not have been well represented in this research (for example, those whose first language is not English and LGBTQI+ individuals)
• examine intersectionality between certain characteristics and/or demographics (for example, the link between gender and ethnicity impacting on appointment choice).

1.4 Additional Notes

This survey is based on the attitudes of the general public rather than their actual experience of each consultation method. This survey was primarily quantitative as it is a module of the wider Social Attitudes Survey, thus no follow up questions could be asked about why a particular answer was chosen.

Finally, this research may have missed a key group in understanding uptake of digital and/or remote appointments as the questionnaire was conducted over the phone, potentially missing those who do not have access to this technology or do not have portable devices. However, this was due to restrictions in place from the COVID-19 pandemic and usually the SSA interviews would be conducted face-to-face.