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Alternatives to face-to-face consultation with GPs.


Communications technologies are routinely used by the public in everyday life, and there is an expectation that this should extend to healthcare.

This expectation is supported by policymakers, who believe that alternatives to face-to-face (F2F) consultation (such as consultations conducted via telephone, email, or internet video) could have a transformative impact on general practice, with advantages in terms of access and resource use.

Evidence to date has assessed the potential impact of some alternatives on clinical outcomes, but research so far has been limited.


A nurse talking with a patient

The aim of the Alt-Con study is to understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations may offer benefits to patients and practitioners in general practice.

The findings will be used to develop recommendations on alternatives to face to face consultations for general practices and a framework for subsequent definitive evaluation.


This is a focussed ethnography study that is conducted in eight different general practices which have tried to use different types of alternatives to face-to-face consultations. The general practices are located in Scotland and England.

Based on interviews with staff and patients, observation of practice life, and anonymised patient records, we explore what practices have achieved, how they did or did not overcome difficulties, and what they perceived were the advantages and disadvantages for different groups of patients.


The AltCon project is a collaborative project of the Universities of Bristol, Edinburgh, Exeter, Oxford, Warwick, and the University of the West of England.

For full details and a list of all those involved in the project: Alt-Con Project website


Our study highlighted that despite the majority of practices offering telephone consultations on a frequent basis, most use email for direct patient care very infrequently and very few use internet video for consultations with patients. In addition, the majority do not plan to implement these methods in the future.

Our findings show that there is currently a lack of clarity about the rationale for introduction of alternatives to the face-to-face consultation and the intended benefits.

Implementation brings considerable challenges, including the potential for changes in the volume and pattern of workload, implications for the roles of practice staff, and for the equitable delivery of care.

When introducing an alternative to the face-to-face consultation the potential for unintended consequences should be considered as these may have a bearing on the potential success of these forms of consultation. However, patients and staff could see potential for benefit from use of a range of types of consultation if these difficulties could be overcome.

A shared understanding within practices of the potential difficulties and extra work that might ensue for reception staff was lacking. This might contribute to the low uptake by patients of potentially important innovations in service delivery.

Involvement of the wider practice team in planning and piloting changes, supporting team members through service reconfiguration, and providing an opportunity to discuss and contribute to modifications of any new system, would ensure that reception staff are suitably prepared to support the introduction of a new approach to consultations.

Guidance on introducing new consultation methods to general practice can be found on the project website.


Alternatives to the face-to-face consultation in general practice: focused ethnographic case study (British Journal of General Practice, 2018)

Receptionists’ role in new approaches to consultations in primary 2 care: focused ethnographic study (British Journal of General Practice, 2018)

Conducting a team-based multi-sited focused ethnography in primary care (BMC Medical Research Methodology, 2017)

Proliferation of private online healthcare companies: Should the NHS try to keep up? (BMJ, 2016)


Funder NHS National Institute of Health Research (NIHR)
Principal Investigator for Edinburgh site Professor Brian McKinstry
Study researcher for Edinburgh site Annemieke Bikker