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  • Led by the University of Aberdeen, in partnership with NHS Grampian and Healthcare Improvement Scotland.
  • Explored the roll out of ‘asynchronous’ consultations at scale in NHS Grampian, to provide practical learning for future use across the NHS.
  • Used mixed research methods, including interviews, focus groups, a survey and analysis of routinely collected NHS data.
  • Ran from November 2020 to July 2022.

COVID-19 changed how NHS consultations are managed, with remote consultation methods (for example phone or video) being widely introduced.

Most research around remote consultations has focused on ‘synchronous’ forms, where patients and clinicians talk online or by phone in real time. There is less research on ‘asynchronous’ consultations, where patients and clinicians are not available at the same time. Examples include emails and text messages, but more sophisticated systems have been developed which are more like the flow of information in face-to-face consultations.

NHS Grampian has been piloting an asynchronous consultation system across a number of care pathways. This involves patients receiving a five-day ‘appointment’ to complete questions online and upload photos. The clinician then looks at these and may request further information, makes a diagnosis or treatment plan, invites the person for a phone or face-to-face appointment, or discharges them.

This research project by the University of Aberdeen explored the roll-out of this system to help NHS Grampian assess the effect on staff and patients, and to provide practical learning for future use across the NHS. 

A multi-method study was designed, including staff, patient and public perspectives via focus groups, interviews and a survey, as well as quantitative data from the NHS. 

Overall, the results demonstrated that the public were positive about asynchronous consultations, with only 18% of survey participants stating that they were explicitly unhappy that they received an invitation to the service. Potential and actual users of the service recognised its usefulness and benefits regarding access, convenience and flexibility for clinicians. 

However, all stakeholders expressed concerns about the potential risk of digital exclusion, and it was acknowledged that there are further opportunities to improve the system, including through better communication with patients.

Study findings have been disseminated widely and the research team is working towards an interventional study to make digital appointments more inclusive with seldom-heard groups.


For more information about this project, please contact Dr Magdalena Rzewuska, Advanced Research Fellow, Health Services Research Unit, University of Aberdeen.

More about the programme

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