Digital first primary care for patients with multiple long-term conditions – the views of staff and stakeholders

Problem

General practices are facing challenges including rising patient demand and difficulties recruiting and retaining GPs. Greater use of digital technology, expediated since the COVID-19 pandemic, has been advocated as a way of mitigating some of these challenges and improving patient access. This includes digital first primary care, whereby digital approaches are used across primary care, from booking appointments to consultations with healthcare professionals. There is little evidence of staff experiences of using digital first primary care with more complex patients such as those with multiple long-term conditions. This study aimed to explore the experiences and views of digital first primary care approaches for use with patients with multiple long-term conditions from the perspective of healthcare professionals and stakeholders (academics, policymakers and providers).

Approach

Eight general practices, using one of two digital first primary care approaches, were recruited to the study with varied demographic characteristics. Interviews were conducted with fourteen healthcare professionals (GPs and nurses) and fifteen stakeholders. Interviews were semi-structured and were audio recorded, with participants permission, and transcribed verbatim. Data were analysed using a thematic framework approach.

Findings

Digital first primary care approaches can enable patients to speak with a healthcare professional more quickly than traditional approaches. Those with multiple long-term conditions can submit healthcare readings remotely, though they may struggle navigating systems not designed to capture the nuances associated with living with multiple conditions. Some health professionals expressed preferences to see patients face-to-face, particularly those with multiple long-term conditions, to identify non-verbal cues about a patient’s health. Staff and stakeholders felt that digital first primary care can be useful for patients with multiple long-term conditions but not at the expense of face-to-face consultations. Digital first primary care approaches may provide an opportunity for carers of patients living with multiple long-term conditions to become more involved in their care, though there were concerns around consent and confidentiality. There remains debate amongst participants about the extent to which digital first primary care impacts on staff workload. Any impacts on continuity of care depended largely on how surgeries implemented digital first approaches.

Consequences

Despite a large volume of the consultations in general practice taking place with patients with multiple long-term conditions, the roll out of digital first primary care, particularly during the COVID-19 pandemic, did not specifically address the needs of patients with multiple long-term conditions.

General practices should be encouraged to reflect on how digital first approaches impact upon patients with multiple long-term conditions, their carers and the health professionals who work with them. There may be economies of scale in terms of expertise, and buying power with providers, for practices commissioning digital first primary care approaches to do so at Primary Care Network or Integrated Care System level.