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

2. Introduction

This introduction will outline the context in which the questions for the SSA 2021/22 were developed and the justification for analysing the results against respondent demographics or characteristics.

2.1 Remote Appointments

Prior to the COVID-19 pandemic in 2020, digital appointments were largely used in secondary care to overcome rurality and only used in specific health boards across Scotland to increase accessibility, reduce carbon footprint of travel to appointments, and ensure healthcare services were delivered more efficiently. In response to the COVID-19 pandemic, the NHS video consulting platform Near Me was quickly rolled out across Scottish health care services and telephone appointments were increased to reduce infection rates among patients and health and social care staff.

During the pandemic, within primary and secondary care, there was a substantial rise in the use of Near Me across Scotland. Guidance for Scotland on 'Improving the use of Near Me Video Consulting in GP Practices' outlines key reasons to use Near Me: to enable physical distancing while still delivering person centered and convenient care. One study also highlighted that some GPs found that video appointments would "sometimes provide[-] clinically crucial information" that could not be captured over the phone. However, as post-pandemic restrictions eased, general practices have since become one of the lowest users of Near Me, opting instead to continue with telephone consultations and offer face-to-face appointments where possible.

The Health and Care Experience Survey 2021/22 reported that only 1% of respondents had a video appointment with their general practice in 2021/22 (compared to less than 1% in 2019/20). In 2021/22, 37% of respondents to the survey reported having a face-to-face appointment and 57% had a phone appointment (compared to 87% and 11% respectively in 2019/20). The 'Public Understanding and Expectations of Primary Care in Scotland: Survey Analysis Report' undertook research on public understanding of primary care. This report examined themes of awareness of accessing primary care services, trust and confidence, and barriers to access. In this report, 36% of respondents who had contacted a health professional in the last 12 months were seen in-person at a general practice. Comparatively, 23% were seen by telephone and only 3% by video. According to a literature review on the use of remote consultations in the UK, clinicians preferred using telephone or face-to-face as it was easier because there was no need to send links/set up video calls. Even during the pandemic, a mixed methods case study found that GPs believed that telephone appointments were often sufficient, and that a physical examination would not be required.

Arguably, the experiences of the health care worker influences their preference to use remote consultations as their primary appointment method. However, this is also largely influenced by digital infrastructure, experience and skills with technology, deciding what is best for the patient, and time efficiency. This report will explore the patient's attitudes towards remote consultation and face-to-face appointments.

2.2 Inequalities and Patient Characteristics

Health and digital inequalities^[3] have been explored in the context of remote appointments and these may impact public attitudes. Self-selected characteristics and demographics have been captured from respondents of this research and will be further explored in the results and discussion chapters^[4].

In 2020, the first National Equality Impact Assessment of the use of Near Me (EQIA 2020) was published. This report highlighted that a move to video consultations as default would disproportionality impact 'protected characteristic groups' (such as women and LGBT people who may not have access to safe and confidential spaces at home), as well as people who experience intersections between characteristics which make them more at risk of inequalities (such as older people from ethnic minority backgrounds). In some cases, certain patients were not offered a video consultation at all. A mixed methods case study reflected on pre- and post-pandemic found that older patients or those who were also assumed to have little digital literacy were offered telephone appointments rather than video. A report based on the experiences of GPs in Glasgow and Edinburgh working in areas of high deprivation in the early months of the pandemic, highlighted the difficulties that remote consultations brought for their patients as many did not have the technology to support telephone or video appointments, some did not have translators, and patients were struggling to describe their condition properly. The patient's choice and skills, their environment, and the clinician's own work set up are influential on the decision making process about which appointment is the most appropriate.

In response to the research around digital health inequalities and accessibility issues, a number of case studies and consulting guidance documents have been made. The NHS England guidelines outlines how to approach appointments for children and young people, older people, and those with long-term conditions. Guidance notes for the use of Near Me in appointments for long term conditions, acute conditions and care homes for NHS Scotland has been made available, as well as general guidance for using remote appointments during the COVID-19 pandemic. However, it is not always easy or appropriate to categorise individuals into groups or labels due to the changing characteristics and health concerns of primary care users, intersections between characteristics and experiences, and an individual's own self-identity.

2.3 Aims and Objectives

There have been a number of studies that examine how individuals feel about video, phone, and a return to face-to-face appointments, many of which include viewpoints from clinical staff, health boards, and other organisations. This report will contribute to the existing research by presenting findings about current attitudes of the Scottish public about remote healthcare appointments specifically in general practices. The aim of this research is to understand degrees of ease and comfort, acceptability, and public attitudes towards general practice appointments as we move out of the pandemic and adopt a more hybrid method of consulting across primary care. This report also aims to identify potential inequalities based on respondent characteristics. Finally, this report hopes to highlight gaps in understanding and make recommendations for future research/policy.