GP remote consultations with marginalised patients and the importance of place during care: a qualitative study of the role of place in GP consultations

Background: Since the COVID-19 pandemic, there has been an increase in the use of remote consultations in general practice in the UK. This leads to the displacement of the consultation outside of the physical general practice, and its 'emplacement' elsewhere, with underexplored consequences for inequities of health care in marginalised groups.

Aim: To examine the place-making demands that remote consultations make on patients, and the ways that these affect their experiences of care, with a focus on the impact on patients from marginalised groups.

Design & setting: Ethnography and interview study (n = 15) undertaken at three fieldwork sites in London: a foodbank, a community development organisation, and a drop-in advice centre for migrants. Additionally, GPs (n = 5) working at practices in deprived areas of London, Digital Health Hub staff (n = 4), and staff at fieldwork sites (n = 3) were interviewed.

Method: Ethnographic observation was undertaken for 84 hours at the fieldwork site services, and semi-structured interviews (n = 27) took place with service users and service providers. Interviews were conducted in-person and over the phone, and data were analysed through reflexive thematic analysis.

Results: The core themes emerging from the data included challenges securing privacy during remote consultations and the loss of formal healthcare spaces as important places of care. These findings were closely tied to resource access, leading to inequities in experiences of care.

Conclusion: Remote GP consultations are not 'place-less' encounters, and inequities in access to suitable spaces may lead to inequities in experiences of care. Attention should be given to ensuring that patients without appropriate spaces for remote consultations are offered in-person care, or consultation times made more specific to allow for organisation of private space.