Control

Case study site staff

Once they had been conducting observations in the practice for a few weeks, the ethnographers identified relevant staff members to participate in the interviews. The ethnographers had made contact with

potential interviewees during non-participant observation, and provided them with the information sheet relating to the interview. If they were willing to participate, an interview was arranged at a time that was convenient for the staff member.

In each practice, administrative staff (including receptionists), GPs and nurses were recruited to be interviewed. When relevant, other members of the practice team were also interviewed, for example, a rural health worker in one practice, a patient manager and an IT manager in another. The team of ethnographers remained in close contact throughout the process, to ensure that the range of staff members being interviewed was suitably varied in regard to factors such as role in the practice, knowledge or involvement in alternatives to the face-to-face consultation.

At the protocol stage, we intended to interview allied health professionals working in general practice, such as phlebotomists and community-based pharmacists. However, it became apparent during observations that, where allied health professionals were working in the practices, they had little to no involvement in the introduction or use of alternatives to face-to-face consultations. Recognising the importance of the wider study team members within general practice, each ethnographer engaged in

informal conversations with these staff members to ensure that their perspectives were covered. These conversations were recorded in the researcher’s field notes and subsequently referred to in the structured summary profile.

Users of video consultation

As described inChapter 3, we recruited an additional four participants from outside the case study sites. These were general practice staff members who were using, were about to use or employed a system that used video consultations.

l We approached practices that had been funded by theGP Access Fund14_{to employ video consultations.} l We approached practices that had publicised their use of video consultation in news articles or reports. l We posted a message on Twitter:

Has your practice offered patients video/skype consults? We are looking for GPs to do a 30m phone interview for AltCon study.

Helen Atherton has 865 Twitter followers and tweets about digital health in primary care. l We used personal contacts (HA and CS) obtained via related research studies.

Two participants were recruited via Twitter, and a further two were recruited via personal contacts (HA). We were unable to contact all of theGP Access Fund14_{practices and, in the case of those we did contact,} we could not identify individuals who were using video consultation. We received no reply from the practices that had publicised their use of video consultation via news articles or reports.

Patients/carers

The aim was to interview patients with different characteristics in relation to age, sex, ethnicity, disability, frequency of attendance and whether or not they had long-term health conditions. All patients invited to participate in interviews had experience of using an alternative to the face-to-face consultation within the practice.

Initially, patients were identified opportunistically, based on those who had engaged in contact with the practice via an alternative to the face-to-face consultation. In subsequent interviews, patients were purposively sampled to ensure that participants with the range of characteristics listed above were included. Practice staff and GPs helped to identify patients and carers and provided potential participants with a study information pack, either via post or in person when attending the practice. This pack included information about the study, an invitation to take part and a reply slip, which they could return via prepaid post. The researcher then called to arrange a convenient time for the interview.

Hard-to-reach and disadvantaged groups

In using a purposive sampling technique, we specifically included people who were identified in the protocol as being in hard-to-reach groups with regard to accessing general practice. Examples included parents/carers of people with complex needs, young men, the vulnerably housed and minority ethnic groups.

The other groups of interest were those that might be disadvantaged by limited provision of alternatives to the face-to-face consultation. These groups were described in the protocol, and further relevant groups were identified in the conceptual review (seeChapter 2). These included patients with mental health conditions, patients living in rural areas, patients with restricted mobility, patients with hearing loss, patients at a great distance from the practice (e.g. working away) and patients with low health literacy and/or low computer literacy.

The aim was to look at the range of problems and issues for these groups, rather than making statements about specific population subgroups. To make it easier for people in these groups to participate, there was flexibility about timings and locations for interviews, with telephone interviews offered when appropriate.

Participants in hard-to-reach and disadvantaged groups were identified by the practices so that they could be invited to interview.