Introduction
COVID-19 has resulted in an unprecedented expansion of virtual consultations in primary and community care services.1 Although virtual consultations have been available for a long time, they were not widely adopted before COVID-19.2 There has now been a rapid deployment of virtual consultations and telephone consultations (TCs) in response to COVID-19.3
Virtual consultations come in many forms, including synchronous TCs, video, text/image messaging and asynchronous email consultations. Virtual consultations enable communication with a range of healthcare staff and are based on an array of provider platforms (Attend Anywhere, WebGP, accuRx, eCONSULT). Digital (or online) triage systems are often linked to virtual consultations, to determine the priority and urgency of a patient condition to manage demand, and are considered the first step in determining whether a virtual consultation is needed. Digital triage is a workflow management system, such as FootFall and AskMyGP. Although much has been written about triage in primary care,4 or indeed the use of the telephone in arranging care,5 relatively little is known about the potential for web-based, real-time (synchronous) communication for some patient groups. Before COVID-19 most practices offered TCs, with few offering video consultations. However, the potential for video consultations, in particular, has still not been realised. In time, these may be considered complementary forms of care delivery.1 2 COVID-19 has led to the rapid expansion of virtual consultations, in its various forms. This commentary paper focuses primarily on web-based virtual consultations.
There are currently vast avoidable inequalities in healthcare and health outcomes (mortality and morbidity) for different service user groups globally.6 This includes Black, Asian, other ethnic and older groups who are also at higher risk of contracting COVID-19 and being adversely affected.7 Evidence collected before COVID-19 indicated the potential of virtual consultations to widen care disparities for specific groups, including people with physical/cognitive disabilities (sensory/communication impairments (audio/sight))8 and those living with social deprivation, with limited digital access (including vulnerable groups)9 10 and areas with poor broadband coverage.11
COVID-19 clinicians and researchers/academics are moving forward in developing ways to mitigate these disadvantages by developing strategies to enable greater access and engagement for a wider range of service users.12 Primary care has adapted rapidly to virtual consultations and embraced their use, despite concerns about confidentiality, safety and security, with the view that many professional and organisational lessons can be learnt to improve access and delivery. To improve delivery moving forward during COVID-19, there is a need to reflect on experiences of delivery, examine and build on current evidence, and consider the training needs and competencies of healthcare professionals delivering care virtually.