Virtual outpatient clinics (where most appointments and consultations are completed remotely) were widely introduced during the COVID-19 pandemic. Most NHS trusts moved to this model of care for TIA clinics to minimise face-to-face contact between healthcare professionals and patients. Some services have continued with a virtual model of care, others have returned to face-to-face clinics or now offer a hybrid approach.
The Oxford AHSN (now Health Innovation Oxford and Thames Valley) and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Oxford and Thames Valley secured funding from the NHS Insights Prioritisation Programme to evaluate the effectiveness of the virtual model and the experiences of patients and staff.
We compared face-to-face and virtual clinics by:
- Mapping the different care pathways in 14 clinics across 12 NHS trusts (across the South East region)
- Interviewing 15 patients and 12 healthcare professionals to gather their views and explore variation in experiences
- Estimating the resource implications and costs of the different pathways
- Exploring the environmental impact of virtual versus face-to-face consultations
Our two main findings were:
- Wide variation across services, even when using the same model. This meant it wasn’t possible to define what a good pathway looks like for each model
- Pathways and working practices were primarily dependent on imaging availability, particularly for MRI
Benefits of the virtual model for patients included time saving due to reductions in travel and time to attend appointments. Healthcare professionals had greater flexibility to manage TIA services around other clinical demands and patients made quicker progress through the pathway.
Challenges of the virtual model included a lack of clear patient facing information. Some patients and healthcare professionals found it more difficult to build a rapport and patients told us they had fewer opportunities to ask questions, particularly when given a diagnosis of TIA and the significance of this on their emotional wellbeing.
Summary and recommendations
There is potential to use virtual consultation for some patients. Developing a framework for commissioners and services to support service design is key and patient input essential. The framework should describe the benefits and disadvantages of the different models, identify when virtual consultation is most appropriate, and address issues around clinic capacity and imaging requirements. We will take forward the findings of this evaluation and work with GIRFT and ISDNs to support the above changes.
‘The delivery of high-quality rapid access TIA services is paramount to reducing the burden of recurrent stroke through early treatment. This work offers a unique and highly valuable insight into the patient and clinician experience of the varying models of face-to-face and virtual consultations.’ – David Hargroves, Consultant Stroke Physician; Clinical lead for Stroke: South East, NHS England; National Speciality Adviser for Stroke Medicine, NHS England; National Clinical Lead for Stroke Medicine – NHS England GIRFT programme.
To learn more about the evaluation, our methods and our findings please access documents and other resources through the boxes below.