Remote services in general practice: who needs to be trained in what, when and how?

Background: Contemporary general practice includes many kinds of remote encounter. Aim: To identify core competencies, training needs and learning methods for staff providing remote encounters. Design and setting: Mixed-method study in UK general practice. Methods: We collated data from longitudinal ethnographic case studies of 11 general practices; a multi-stakeholder workshop; interviews with policymakers, training providers and trainees; published research; and grey literature (e.g. training materials, surveys). Data were coded thematically and analysed using theories of individual and team learning. Results: Learning to provide remote services occurred in the context of high workload, understaffing and complex workflows. Low confidence and perceived unmet training needs were common. Training priorities for novice clinicians included basic technological skills, triage, ethics (e.g. privacy, consent), and communication and clinical skills. Established clinicians’ training priorities include advanced communication skills (e.g. maintaining rapport and attentiveness), working within the limits of technologies, making complex judgements, coordinating multi-professional care in a distributed environment, and training others. Much existing training is didactic and technology-focused. Whilst basic knowledge was often gained using such methods, the ability and confidence to make complex judgements were usually acquired through experience, informal discussions and on-the-job methods such as shadowing. Whole-team training was valued but rarely available. We offer an outline set of competencies based on our findings. Conclusion: The knowledge needed to deliver high-quality remote encounters to diverse patient groups is complex, collective and organisationally-embedded. The vital role of non-didactic training eg: joint clinical sessions, case-based discussions and in-person, whole-team, on-the-job training needs to be recognised.