Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study

Abstract

Background Scotland—a country of 5.5 million people—has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. Objective To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland’s video consultation services both before and during the pandemic. Methods Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. Results By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations’ general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. Conclusions The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.

Achieving Spread, Scale Up and Sustainability of Video Consulting Services During the COVID-19 Pandemic? Findings From a Comparative Case Study of Policy Implementation in England, Wales, Scotland and Northern Ireland

“…Findings from our research suggest that this policy narrative, and the mismatch with frontline experiences, has continued during the pandemic: what decision makers viewed as an opportunity to scale up video consulting appeared to be at odds with what many in primary care viewed as disruption in terms of the work involved in "rapidly shifting existing organizational practices to new digital spaces" [(104), p. 4]. This builds on earlier work on technological innovation in health care and the challenges of routinizing new technologies in everyday practice [e.g., (48,74,123)].…”

“…This work involved quantitative and qualitative data collection and the production of narrative case studies to illustrate the successes, failures and partial successes of efforts to use this technology in different settings and services. The Scottish example is interesting because much work was put into building a national infrastructure and branding for the video consultation model (48). We were then commissioned by the Scottish Government to extend this work and document how things changed during the COVID-19 response.…”

“…Our focus is on the UK National Health Service (NHS). In the context of COVID-19, policy across the UK four nations has been to facilitate roll out, spread and scale-up of remote consulting as a means of managing the risk of infection while continuing to deliver safe and accessible health care (48). This was overseen by the then Secretary of State for Health, Matt Hancock, who took up position in 2018 with the ambition of making the NHS more digitally enabled (earning him the nickname "Matt The App")-since the start of the pandemic in 2020 he repeatedly called for NHS services to become "remote by default" (49,50).…”

Lessons from experiences of accessing healthcare during the pandemic for remobilizing rheumatology services: a national mixed methods study

“…These findings may reflect differences in clinical need and the ability to engage in remote consultations as well as their perceived effectiveness for a given problem. Such individuals may have greater overall debility and fewer resources to effectively access remote delivered healthcare, as illustrated by Wherton et al [ 40 ] in a study of video consultations pre and during the COVID-19 pandemic in Scotland. They found that comorbidities and pre-existing conditions, along with a general level of debility influenced people’s ability to use video technology.…”

Digital Inclusion as a Foundation for Health Equity. Comment on “Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study”

“…This insightful paper by Wherton et al [ 1 ] suggests groundwork before the pandemic allowed health care services to rapidly extend the use of video consultations across Scotland. As a general practitioner and digital champion, working in a deprived area in a city in Scotland, I agree but strongly believe that front-line staff is fundamental to further increase use.…”