'To see or not to see?' That is the question: teleconsultations in primary care and the impact on 2-week-wait referrals and outcomes

ABSTRACT

The COVID-19 pandemic has resulted in an unprecedented change to service delivery within the National Health Service (NHS). After the UK government advised general practitioners to conduct consultations remotely where possible, remote consultations rose from < 30% before the pandemic to almost 80% of consultations at the height of the pandemic. After the national lockdown was lifted, remote consultations continued to account for > 70% of consultations. Telemedicine has previously been shown to be an effective model for triaging referrals from primary care to 2-week-wait (2WW) skin cancer clinics. However, to our knowledge, no study has assessed the impact of telemedicine in assessing patients remotely at their initial primary care consultation prior to referral to secondary care. Our study aimed to assess whether the mode of consultation [face to face (F2F) or remote] in primary care affected the outcomes of consultations in 2WW skin cancer clinics. In total, 988 patients were referred to the 2WW clinic in September 2020. Of these, 37 9% (n = 375) were referred after F2F consultations in primary care. Thirty-seven per cent (n = 364) were referred after remote consultations, with the majority being telephone consultations with photographs (76%). The mode of primary care consultation was unclear in 21 1% (n = 209) of patients. A higher proportion of patients who had remote consultations were discharged (43 4%;n = 158/364) from the 2WW clinic than patients who had F2F consultations (36 2%;n = 136/375). There was a significantly higher number of benign lesions referred following a remote consultation in primary care compared with a F2F consultation (70% vs. 59%;P = 0 004). Interestingly, there was a higher proportion of benign lesions referred after telephone consultations with photographs vs. those without. The accelerated use of telemedicine in the COVID-19 era will provide useful information on how telemedicine can be optimized in the future. Lessons learnt during this time will inevitably shape the future digital landscape within the NHS. A key ambition set out in the NHS Long Term Plan published in January 2019 was to increase remote consultations within primary care. While remote consulting certainly has a role in some settings, our study highlights the value of F2F consultations for the initial assessment of patients presenting with lesions in primary care, in order to reduce the number of unnecessary referrals and hospital visits.