Patient Experience of Remote GP Consultations in Relation to Multimorbidity and Socioeconomic Status

Problem

Multimorbidity is a significant and pressing burden for the individual sufferer, society, and the NHS. Multimorbidity accounts for the majority of GP consultations with more than half the UK population over 65 years affected. Disproportionately affecting those who are disadvantaged in other ways: social deprivation, non-white ethnicity, mental ill-health, disability, increasing age and female gender are all associated with multimorbidity. These factors are also associated with digital exclusion and the digital divide. This is important because it is not known how the sudden transition to remote GP consultation, and the reliance on digital consultation methods during the COVID-19 pandemic has affected patient experience of accessing healthcare. Aim is to explore how a person’s multimorbidity and socioeconomic status interact to affect their experience of accessing healthcare, and the impact of the transition to remote GP consultation during the COVID-19 pandemic.

Approach

A co-production approach has been taken to develop a phenomenological, qualitative interview study informed by epidemiological analysis of a local shared care record, as part of a NIHR PhD project. Sampling of people with multimorbidity will include people with serious mental illness and learning disability as well as the elderly, homeless and asylum seekers. This choice of cohorts is informed by the literature, public consultation and epidemiological data from a shared care record. This novel approach will evaluate the utility of a shared care record as an integrated care system. The semi structured interviews have been co-designed with specific public advisors to maximise acceptability and access for the participants. Recruitment is by invitation, in collaboration with several NHS and community organisations across the Northwest of England.

Findings

This study will expose taken-for-granted assumptions about healthcare access, contributing authentic and timely understanding of the lived experiences and circumstances that affect a person’s ability to access, or not access, their GP via remote consultation. The COVID-19 pandemic has highlighted many existing inequalities. Evaluation of the inequality of digital exclusion and its impact on healthcare access during this time will provide essential learning to health care professionals and service providers.

Consequences

This research will provide new insight into how to mitigate the impact of digital exclusion and the digital divide on health care access. Adaptation of GP services is necessary for those who are at risk of digital exclusion, particularly in light of the NHS long term for digitally- enabled care. Healthcare providers must adapt in practical, relevant, acceptable, and effective ways. This investigation will also give voice to the experiences and opinions of some of the groups of people who are typically excluded from research.