Use of video group consultations by general practice staff during the COVID-19 pandemic
Intended for healthcare professionals
Evidence and practice    

Use of video group consultations by general practice staff during the COVID-19 pandemic

Eleanor Scott PhD student, school of nursing and midwifery, Keele University, Staffordshire, England
Laura Swaithes Knowledge mobilisation research fellow, Keele University, Staffordshire, England
Gwenllian Wynne-Jones Professor, Keele University, Staffordshire, England
Andrew Finney Senior lecturer and postdoctoral researcher, Keele University, Staffordshire, England

Why you should read this article:
  • To explore the use and uptake of video group consultations (VGCs) by UK general practice staff during the COVID-19 pandemic

  • To enhance your awareness of the potential use of VGCs in your clinical setting

  • To recognise that the use of VGCs is dependent on funding, organisational support, general practice priorities and understanding of the model

Background: Video group consultations (VGCs) are one approach to delivering care using a virtual platform for a group of patients with the same or similar health conditions. However, little is known about the use and uptake of VGCs in the UK.

Aim: To describe the use and uptake of VGCs by UK general practice staff during the coronavirus disease 2019 pandemic.

Method: A cross-sectional design using an online questionnaire. Data analysis adopted the principles of content analysis and demographic data were analysed descriptively.

Findings: A total of 36 participants completed the questionnaire across nine UK regions and representing 36 general practices. A lack of standardisation regarding the use and uptake of VGCs across UK general practices was identified, hindering implementation, scale-up and delivery.

Conclusion: While the VGC model looks promising, further research is needed to demonstrate its use and uptake, developing a more robust evidence base for implementation.

Primary Health Care. doi: 10.7748/phc.2023.e1801

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software



Conflict of interest

None declared

Scott E, Swaithes L, Wynne-Jones G et al (2023) Use of video group consultations by general practice staff during the COVID-19 pandemic. Primary Health Care. doi: 10.7748/phc.2023.e1801

Published online: 21 June 2023


Over the past decade, the NHS and primary care general practice have experienced several challenges. Policies such as the Five Year Forward View (NHS England (NHSE) 2014) and General Practice Forward View (NHSE 2016) proposed new and more efficient models of integrative and collaborative care, meaning that practices have greater control over funding and service design (NHSE 2016). The NHS Long Term Plan (NHSE 2019) attempted to further establish novel ways of working with the development of primary care networks and integrated care systems, which have combined services and expanded primary care roles to increase accessibility for local populations (NHSE 2019).

These newer ways of working extended to the use of group consultations in general practice, meaning that clinicians can consult with multiple patients with the same or similar medical condition at once (Ramdas and Darzi 2017). Group consultations are effective in delivering patient education and health promotion (Wadsworth et al 2019, Papoutsi et al 2022). Although this approach has been used in primary care, there is limited evidence to prove its efficacy in practice or address the growing challenges with increased populations, backlog and disease severity (National Institute for Health and Care Research 2016).

Implications for practice

  • The novelty of video group consultations (VGCs) across primary care general practice means that there is a need to address their value in theory and practice

  • Studying the use and uptake of VGCs can help to provide an insight into how VCGs are defined, delivered and described

  • Future research will help to develop a greater understanding of the use and uptake of VGCs, aiding more coherent delivery and implementation of this model across the UK

In 2020, general practice services had to restructure due to the coronavirus disease 2019 (COVID-19) pandemic stimulating a digital shift. COVID-19 had a significant effect on the ways in which healthcare services were run, with the need to reduce footfall in general practice settings (Greenhalgh et al 2020). While digital transformations had been slow over the previous 20 years, the NHS had to quickly adopt a digital approach to care (Birrell et al 2020, Greenhalgh et al 2020). Face-to-face consultations were reduced to stop the transmission of COVID-19, and alternative methods of care delivery were used, including online consultations by video or telephone.

The initiation of video group consultations (VGCs) was one response to the COVID-19 pandemic and a potential way of future-proofing primary care services from further challenges (Papoutsi and Shaw 2021). However, due to the novelty of the approach, many practices were reluctant to test or adopt VGCs, with a clear disparity in engagement (Clarke et al 2020). Understanding why and how some practices choose to offer VGCs will generate the development of a robust evidence base and support understanding of implementation of VGCs in practice.

Video group consultations

VGCs, also known as virtual group clinics or video-shared medical appointments, are an alternative model of consultation, offering clinicians a way to deliver the same standard of patient care using a virtual environment and a group consultation model (Birrell et al 2020). VGCs differ from face-to-face group consultations as they are conducted using a virtual platform.

VGCs are still relatively new in the UK and demonstrate a small evidence base globally due to their novelty (Papoutsi and Shaw 2021). During the COVID-19 pandemic, training providers rapidly initiated VGCs training for staff. However, the implementation, delivery and effect of VGCs have not yet been fully evaluated because of the enforced and increased pace of newer ways of working.


To describe the use and uptake of VGCs by UK general practice staff during the COVID-19 pandemic. The associated study question was: ‘What is the use and uptake of VGCs by healthcare professionals in UK primary care general practice?’



A cross-sectional design using an online questionnaire was adopted. Cross-sectional studies follow a transverse design, where a sample of participants are analysed at a specific point in time (Peat 2002). A questionnaire also captures a variety of data using closed and open-ended questions, producing both descriptive statistics and qualitative data.

The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist (von Elm et al 2007) was used to ensure accurate and comprehensible reporting, to facilitate both critical appraisal and interpretation of results.


Participants were selected based on their exposure status, with the researchers targeting a population relevant to the study question (Wang and Cheng 2020); that is all clinical and non-clinical staff who used or had previously used VGCs in their primary care general practice. Any clinical and non-clinical participants who were not working in primary care general practice were excluded.

Three sampling methods, purposive, random and snowball, were used to identify a broad range of individuals and practices using VGCs, varying geographical locations and professions (Roy et al 2020).

Purposive sampling was achieved by using the FutureNHS ( collaboration platform to identify individuals who had been involved in routine VGCs and met the eligibility requirements for the study. Purposive sampling was used to ensure that the collection of data was relevant and pertinent to those using VGCs in general practice.

Random sampling was achieved using social media platforms (Facebook and Twitter) with the ability to reach a large audience through virtual networks. Participants were able to include themselves in the study if they met the eligibility requirements determined by a tick-box system. Once this was completed, electronic consent to take part in the study was obtained and participants were able to access the questionnaire. Without confirming eligibility and gaining consent, the questionnaire was unable to be completed.

Snowball sampling was used to capture a larger audience through professional networks.

Sampling continued until the period of recruitment ended and no further participants were identified.

Data collection tool

An initial questionnaire was devised and piloted by a stakeholder advisory group and informed by systematic scoping searches. This informed the development of the final questionnaire. To ensure the questions in the final questionnaire were relevant not only to the study topic but also to the participants, questions were tailored dependent on the answers previously provided in the initial pilot questionnaire. A mixture of quantitative and qualitative questions was asked.

The final questionnaire was available to access for two months (November 2021–January 2022) through Microsoft Forms, an online survey creator. The questionnaire consisted of six broad areas:

  • Participant demographics (quantitative).

  • Participant professional roles (qualitative and/or quantitative).

  • Practice demographics (quantitative).

  • The use of VGCs (qualitative and/or quantitative).

  • Enablers and barriers to the use of VGCs (qualitative and/or quantitative).

  • Training requirements (qualitative and/or quantitative).

Data analysis

Data analysis was conducted by the first author (ES), supported by the study team (AF, LS, GW-J). All data were analysed anonymously.

Inductive content analysis was used to analyse qualitative data, by analysing manifest and descriptive content to develop categories, resulting in themes (Elo and Kyngäs 2008, Graneheim et al 2017, Lindgren et al 2020).

Demographic data were analysed descriptively and used in combination with the themes to provide a context for interpretation and discussion.

Ethical considerations

Ethical approval was obtained from the research ethics committee, faculty of medicine and health sciences at Keele University (ref 2022-0312-315). All data were anonymised to ensure confidentiality.


Participant and practice demographics

The total number of questionnaires distributed was unknown due to the sampling methods used and the anonymity of the data and analysis. However, due to the limited evidence on VGCs, it was considered valuable to analyse the responses that were received and therefore the response rate was not a primary consideration. After exclusions and incomplete questionnaires (n=2), 36 participants, representing 36 general practices, completed the questionnaire across nine regions of the UK. Table 1 outlines the participants and practice demographics. Each participant was assigned a number which is used in this article alongside their job type when using direct quotes below.

Table 1.

Participant and practice demographics (n=36)

  • Female

  • Male

  • Prefer not to say



Age group (years)
  • 18-24

  • 25-34

  • 35-44

  • 45-54

  • 55-64





Professional role
  • GP

  • GPN


  • AHP

  • Practice manager

  • Social prescriber






Other roles (non-clinical)
  • Health coach

  • Digital coordinator


Practice location (region)
  • North east England

  • North west England

  • Yorkshire and the Humber

  • West Midlands

  • East of England

  • London

  • South east England

  • South west England

  • Scotland









Practice size (thousands)
  • 0-2,000

  • 2,000-5,000

  • 5,000-10,000

  • 10,000-15,000

  • 15,000-20,000

  • 20,000-25,000

  • >25,000








GPN=general practice nurse; ACP=advanced clinical practitioner; ANP=advanced nurse practitioner; AHP=allied health professional


Four themes were identified from the questionnaire data:

  • Definition and use of VGCs.

  • Staff and patient motivations for using VGCs.

  • Workload and practice priorities.

  • Using pre-existing and new networks to sustain VGCs.

Definition and use of video group consultations

Understanding how VGCs were defined was central to the use of the approach, determining its purpose and scope in practice. The terms ‘video group consultation’ (n=22) or ‘video group clinic’ (n=12) were reported most by the participants. Educational therapy (n=5), support group (n=6) and group therapy (n=1) were also reported as features of VGCs, yet also became a defining characteristic for some participants. Shared medical appointment (n=1) was not chosen as a widely used definition for VGCs.

Participants were asked, ‘How would you define how you use VGCs in your practice?’ The most frequently reported definitions of use was for long-term condition reviews (n=25), detailing several conditions, including diabetes (n=4) and cancer (n=1). Terms such as ‘management’ (n=2) and ‘chronic disease’ (n=1) were also identified in relation to long-term condition reviews.

The principles of ‘group support’ and ‘health promotion’ were also used to define the use of VGCs. Group support included ‘providing discussion’ (P19_GP), ‘interactive questioning’ (P19_GP), ‘another method of connecting’ (P15_GP) and ‘experience sharing’ (P34_GP). One participant defined a VGC as ‘an online group that enables discussion among a group of patients with similar health issues’ (P14_general practice nurse (GPN)). Health promotion included goal setting (n=1), coaching (n=2), promoting health (n=1) and providing information (n=9). Lifestyle medicine (n=8) was also viewed as an aspect of health promotion as a means of lifestyle advice (n=4), for example for patients with rheumatoid arthritis (n=1), weight management (n=1), cognitive behavioural therapy in menopause groups (n=1), postnatal care (n=1) and mental health (n=1). One participant defined VCGs as ‘providing information on a dietary approach to diabetes plus supporting patients if they chose to follow that plan in de-medicating’ (P31_GP).

The scope and role of VGCs extended to the management of conditions, mostly identified as type 1 and type 2 diabetes (n=25, 27%) and weight management (n=16, 17%) (Figure 1). However, support for the use of VGCs in various patient groups was usually dependent on organisational and practice support in that ‘practice is keen to support cohorts such as those with pre-diabetes, mental health so we have explored using VGCs to offer targeted support to these individuals’ (P30_social prescriber).

Figure 1.

Conditions managed using video group consultations (n =92)*


Participants were asked, ‘Do you manage any other conditions through VGCs?’ Two main categories were identified related to health prevention (n=10) or health promotion (n=2). Health prevention included conditions such as diabetes, including pre-diabetes and newly diagnosed diabetes (n=3); men’s health and women’s health, including menopause (n=4); cancer (n=1); dementia (n=1) and postnatal care (n=1). Conditions and/or activities related to health promotion included exercise classes (n=1), with the aim of disease prevention (n=1). However, one participant described how the topics included in VGCs was determined by the patients themselves, stating: ‘we allow patients to leave a message requesting a topic they want group clinics to cover, and we will offer group clinics in any area requested by the patient’ (P01_GP).

Staff and patient motivations for using video group consultations

Participants talked about their motivations and their perceptions of patient motivations for the use and uptake of VGCs in practice. Of the participants, 27 (75%) currently used VGCs, while nine (25%) had previously used the approach and stopped. Participants were asked, ‘If you have previously used VGCs and stopped, why have you stopped?’ Two reported that VGCs were not continued if a ‘specific programme ended’ (P23_social prescriber) or ‘the health coach who was providing the facilitator role moved away’ (P33_GP).

Uptake of VGCs was therefore dependent on staff and perceived patient motivations. In terms of staff uptake of VGCs, ‘challenging doubters’ (P21_advanced clinical practitioner/advanced nurse practitioner (ACP/ANP)) was an issue, with some participants citing difficulties in ‘changing perceptions of group consultations’ (P21_ACP/ANP) and ‘reluctance of certain clinicians to engage’ (P28_GP). One participant identified that reluctance to change was grounded in individuals ‘being stubborn’ (P03_ACP/ANP) and the belief that ‘most people working in primary care already have the necessary skills’ (P06_GP).

Participants described several attributes that staff would require to use VGCs (Box1). These attributes ultimately helped in ‘believing in the model’ (P03_ACP/ANP) and ‘confidence in getting the change project up and running’ (P04_GP).

Box 1.

Attributes that staff needed to use video group consultations

  • ‘Determination’ (P12_GPN)

  • ‘Enthusiasm’ (P14_GPN)

  • ‘Personal interest’ (P18_GP)

  • ‘Desire to be more digital’ (P15_GP)

  • ‘Confidence to have discussions with a group of people’ (P03_ACP/ANP)

  • ‘Empathy’ (P09_HC)

  • ‘Patience’ (P09_HC)

  • ‘Approachability’ (P32_PM)

  • ‘Adaptability’ (P12_GPN)

  • ‘Personable’ (P20_AHP)

  • ‘Engaging’ (P20_AHP)

  • ‘Emotional intelligence’ (P20_AHP)

  • ‘Thinking outside the box’ (P27_NC)

  • ‘The ability to motivate and inspire’ (P20_AHP)

  • ‘Time management’ (P20_AHP)

  • ‘Problem solving’ (P27_NC)

  • ‘Good consultation skills’ (P03_ACP/ANP)

  • ‘A sense of humour’ (P21_ACP/ANP)

GPN=general practice nurse; ACP=advanced clinical practitioner; ANP=advanced nurse practitioner; HC=health coach; PM=practice manager; AHP=allied health professional; NC=non-clinical (a grouping together of roles named as non-clinical, including health coach and digital coordinator)

Several training needs were also identified by participants and deemed important for staff motivation to use VCGs, mostly related to facilitation skills, including the ability to facilitate a group session, and manage group dynamics and challenging circumstances. One participant stated that the delivery of VGCs was dependent on ‘someone who understands the tech and can act as a master of ceremonies’ (P19_GP). However, facilitation skills (n=32) were also considered more broadly, in terms of presentation skills (n=3), IT skills (n=6), digital literacy (n=2), coaching skills (n=3), group management skills (n=11), communication skills (n=5), administration skills (n=1) and a variety of content to ensure adaptability (n=1). Five participants listed the need for facilitator training and increased ‘IT literacy for when things go wrong’ (P08_GPN). However, another argued that ‘time needs to be given so clinicians can understand the benefits’ (P28_GP) and therefore make sense of the skills and training needed to deliver a VGC.

Despite this, participants perceived that patient motivation was key to the use and uptake of VGCs, with one stating ‘our local population was “Zoomed” out [an expression of overuse of virtual platforms including Zoom] and haven’t taken up the opportunity for VGCs as enthusiastically as they took up the invitation for face-to-face GCs’ (P31_GP). Attendance by patients was therefore identified as a major issue, with one participant stating ‘we will often recruit eight or so patients but none will attend after multiple reminders’ (P09_health coach).

Participants also perceived patients’ use of technology as central to suboptimal uptake. It was perceived that the ‘older population rejecting the idea of “new-found” tech’ (P05_GPN) related to a high VGC ‘did not attend’ rate. One participant stated, ‘while most patients have access to a compatible device, many lack confidence in technological ability and declined or came into difficulties joining or during the VGC’ (P20_allied health professional (AHP)). Participants (n=32) identified the patient age group most commonly using VGCs were those aged between 40 and 50 years.

Some participants related perceived suboptimal patient uptake to access issues, rather than motivation, identifying that ‘patients frequently declined on the basis of availability’ (P20_AHP) because ‘only one VGC date was confirmed at a time with no indication of the next’ (P20_AHP). However, ‘some patients are pro VGCs, as they see it is a time saver’ (P36_social prescriber).

Other perceptions related suboptimal patient uptake to the choice of face-to-face or VGC. There was a perception among participants that when given the choice between face-to-face consultations or VGC, patients preferred face to face, with one participant stating ‘we are planning to run a pre-diabetic VGC but are debating this in-person rather than tech as our patients appear to prefer in-person options’ (P30_social prescriber).

In addition, perceived patient uptake of VGCs was dependent on preference for a group versus an individual approach, as one participant noted that it was ‘slow starting to get the numbers for our group consultations as still offering 1:1’ (P10_ACP/ANP), while others noted that ‘some love and some prefer individual input’ (P08_GPN) and ‘others prefer in-person, as they like the companionship of others’ (P34_GP). Uptake was therefore dependent on targeting the appropriate patient population and acceptance of a new consultation model.

Workload and practice priorities

Workload and practice priorities were key to the set-up and delivery of the VGCs approach. The lack of facilitation and support were the main reasons why practices stopped delivering VGCs, including clinical support (n=1); technological support (n=1); administrative support, such as preparation of resources (n=2); time intensity (n=1); additional workload (n=1); and lack of capacity (n=1). One participant stated that ‘they [VGCs] are time intensive for small turnout in terms of prep of resources, tech support, two clinicians presenting and someone on the chat box’ (P30_social prescriber).

The time taken to deliver each VGC was identified as between 60 and 90 minutes (n=24, 67%), predominantly involving either four to six patients (n=14, 39%) or six to eight patients (n=13, 36%). Therefore, ‘having the time to build these sessions’ (P27_non-clinical) was paramount because ‘once foundations are in place some sessions can run on self-referrals, reducing admin processes’ (P21_non-clinical). However, one participant stated that this relied on ‘having more people to help than just one person doing it’ (P07_GPN).

Participants were asked, ‘What other factors have played a role in the set-up of VGCs?’ Although participants did not have to answer this question, 26 did. More than half of responses (n=14/26, 54%) related to organisational and practice support, including practice and/or group support (n=3), administrative support during and in the initial work-up (n=3), support from GPs (n=1) and commissioning investment (n=4).

Participants were also asked, ‘Did your practice already deliver group consultations before offering VGCs?’ Of the participants, 22 (61%) responded ‘no’, 13 (36%) answered ‘yes’ and one (3%) responded ‘not sure’. Successful workforce planning was therefore identified as crucial (n=18), due to the unestablished nature of the VGC model and the associated workload required to get the approach ‘up and running’. Planning (n=3), time (n=4), availability and scheduling (n=7), training (n=2), and administrative support (n=2) were all factors that the participants stated could contribute to the ability to provide VGCs as an alternative model of consultation. However, ‘a lack of investment in staff who are able to do the VGC’ (P14_GPN) meant that participants noted issues with the viability of the approach, stating ‘[I] wish I had more protected time’ (P32_practice manager), that there was ‘no time for planning recall of patients’ (P03_ACP/ANP) and that there were challenges with ‘getting certain members of the practice on board’ (P04_GP). One participant also identified that ‘staff training and availability is a huge challenge, as is getting allocated time for VGCs within the clinical day’ (P33_GP).

Training was identified as key to the use and uptake of the VGC approach, with most participants being involved in formal training sessions (n=24, 67%). Formal training (n=22), including the need for ongoing support and accreditation (n=2), was identified as a necessary requirement for the delivery of VGCs. However, one participant stated that VGCs ‘can be easily done without the training too’ (P35_GP), while another stated that ‘the best training is to “just do it”’(P31_GP).

Participants provided more than one answer to the question on barriers to the use of VGCs with the total number of responses reaching 100. The use of technology was identified as the second largest barrier to the use of VGCs (n=22/100, 22%).

Microsoft Teams was identified as the most favoured platform to deliver VGCs (n=28, 78%). However, one participant stated that ‘the technology [is] still not mature enough’ (P15_GP) to deal with newer ways of working, ultimately leading to a lack of confidence in systems such as the digital platforms used to host VGCs.

Using pre-existing and new networks to sustain video group consultations

The lack of sustainability when using VGCs was reported as a challenge. One participant described ‘primary care being “stuck in a rut”’ as practices were ‘too busy to innovate’, ‘GDPR [General Data Protection Regulation] stifling innovation’ and a ‘lack of funding to do things differently’ (P01_GP). Another participant described sustainability as dependent on a ‘culture shift’ (P28_GP). The sustainability of VGCs was also seen as being dependent on organisational support, with participants stating that ‘we were commissioned to provide the service for a primary care network’ (P31_GP), and with some practices having ‘CCG [clinical commissioning group] locally commissioned services incentivising group consultation delivery’ (P33_GP).

Participants who managed to sustain VGCs identified the need to use pre-existing and new networks. Techniques such as liaising with other practices and using experts already running VGCs were echoed across participants’ responses as a way of ‘showing how others are run’ (P07_GP). This also included the need to use a formal VGC training provider and incorporate established consultation models such as a long-term condition review or lifestyle medicine template into any VGCs.

When implementing VGCs, participants also described the benefits of ‘training in delivery’ (P11_ACP/ANP), stating that ‘it was useful to have the training of flow’ (P35_GP), and that ‘training on the technical side was very helpful’ (P30_social prescriber) alongside ‘on-going support/accreditation’ (P01_GP). Participants further identified the need for whole-team ‘buy-in’ rather than having an individual champion to initiate, deliver and sustain the VGC approach, due to the associated workload.


To the authors’ knowledge this is the first cross-sectional survey of UK general practice staff to explore the use and uptake of VGCs in primary care. Each finding exemplifies issues related to both the use and uptake of the approach. Of the four identified themes, definition relates to ways in which VGCs are being defined in practice and how this affects the uptake of the approach. The theme of staff and patient motivations describes both the use and uptake of the VGC approach, dependent on how it was understood in practice. Workload and practice priorities referred primarily to the uptake of the VGC approach, but indirectly affected how it is used. The theme of using pre-existing and new networks to sustain VGCs identified descriptions regarding the uptake of the approach.

Only participants who had used or previously used VGCs in primary care were included, due to the small prevalence of use across the UK. Excluding participants who had not delivered or set up VGCs meant that the data were focused on the study aim. The use of content analysis was well suited to the open-ended nature of the questions because it allowed for the fluidity of participant responses within the domains of the research question and aided pragmatic application in healthcare (Elo and Kyngäs 2008, Krippendorff 2018).

The study findings demonstrate a unique contribution to knowledge of VGCs, whereby the overlapping findings reflect the complicated nature of embedding complex interventions into practice. Normalisation process theory (NPT) focuses on the active work people and groups ‘do’, capturing the process of strategic change involved in sustaining an intervention, and aiding a greater understanding of how concepts are operationalised, engaged with, reflected on and evaluated in the ‘real world’ (May et al 2016, 2018). Therefore, the authors used NPT to aid discussion of the data, recognising the complexity of healthcare systems and the dynamics of implementing complex interventions, and focusing on four key constructs: coherence, cognitive participation, collective action and reflexive monitoring (May et al 2018, Saunders et al 2022). NPT was used as a method of understanding the ways in which ‘complex interventions’ such as VGCs can be embedded into practice.

New discussion themes were matched and discussed and related to the four constructs of NPT, to make sense of a diverse range of findings, as follows ‘Understanding the role of VGCs’ (coherence), ‘Achieving practice and patient buy-in’ (cognitive participation), ‘Operationalising a new consultation model’ (collective action) and ‘Evaluating complex interventions’ (reflexive monitoring) (Figure 2) (May et al 2018).

Figure 2.

Schematic representation of study themes matched to the four constructs of normalisation process theory


‘Coherence’ involves staff developing both an individual association and shared understanding of an approach such as VGCs, which enables practices to adopt a pragmatic and comprehensible intervention (May et al 2018). While participants described the varied use of VGCs, most defined the primary use as being for long-term condition reviews. This establishes the fluidity of what is a ‘consultation’ in general practice, distinct from group support or educational therapy. Therefore, the lack of standardisation and shared definition (for example, in the way that a long-term condition was defined) influences how VGCs are translated, understood and worked in practice, affecting the VGC’s viability as an alternative model of consultation.

This study also identified the importance of achieving practice and patient buy-in, aligning with the ‘cognitive participation’ construct of NPT, describing the work behind initiating new practices and the motivations for driving it forward, considering the involvement of others. It is therefore important to consider the effect of patients, alongside staff, in terms of the use and uptake of VGCs in future research studies.

In addition, participants described the operationalisation of VGCs in practice, in terms of practice commitment, workload, technology and training, reflecting the need for ‘collective action’ surrounding the implementation of new interventions into everyday practice. Definition regarding role and scope therefore affects how VGCs can be operationalised into practice.

Furthermore, it is important to note that a lack of evaluation aimed at sustaining the use of VGCs reflects the current position of primary care and the barriers associated with embedding complex interventions, which coincides with the construct of ‘reflexive monitoring’. The effects of COVID-19 have meant that while there are many case studies reporting on the use of the VGC approach, strong evidence-based research is limited. The need to provide an evidence base for future use of VGCs in primary care general practice will promote the implementation of such complex interventions.

One consideration of the fluidity of this complex intervention cannot be encompassed by NPT alone. Papoutsi et al (2022) reiterated the need for the characterisation of VGCs, providing definitions for different remote group-based care formats, including clinical, educational, informational and mixed. The findings of Papoutsi et al (2022) are synonymous with this study, in which definition and the term ‘consultation’ are characterised dependent on practice needs, organisational capacity and training provider priorities. In addition, Papoutsi et al’s (2022) categorisation resonates with the work of Swaithes et al (2021) who demonstrated a varied use and definition of the face-to-face group consultation model, and therefore may allude to the transferability of findings across both face-to-face and virtual settings.


Limitations include the small sample size (n=36). It is evident that while there is some use for VGCs in general practice settings, uptake is not on a broad scale. Although UK practices which have undertaken VGC training were targeted by the researchers, the use and uptake of the approach is dependent on a number of factors, including funding, organisational support, practice priorities and understanding of the model itself (Papoutsi et al 2022), therefore affecting the consistency of participation in VGCs. However, the spread of participants across nine regions of the UK reduced bias.

The risks of using social media when conducting a study, such as not producing a representative sample of the population, were discussed dependent on where the questionnaire was posted or distributed. There may have been a greater response in particular regions by using social media, for example in areas where clinicians shared information with other clinicians in their practice. The use of both professional social media sites and the researchers’ social media accounts helped to ensure participants did not develop an ‘echo chamber’ (Cinelli et al 2021) of knowledge regarding study participation; that is, an environment whereby a person only encounters knowledge, beliefs or opinions which coincide with their own. The virtual nature of the study sampling also attempted to mitigate the constraints of COVID-19 restrictions on recruitment.

Further consideration of the external context and pressures facing general practice at the time of data collection – mainly COVID-19 and the restrictions that came with adapting to a newer way of working – may also have resulted in a smaller sample population. Studies completed at a similar point in time exploring the experiences of virtual consultations also had low response rates across community settings, including general practice (Ackerman et al 2020, Proulx-Cabana et al 2021).

In addition, this study focused distinctly on VGC methods, and did not examine the contribution of face-to-face group consultations, which may have increased uptake. The sample also meant that only the views of staff were captured, and patient motivations were discussed in relation to staff perceptions. The cross-sectional nature of the study also meant that this data set only captured one point in time, limiting the generalisability of the findings.


This study has explored the use and uptake of VGCs by UK general practice staff during the COVID-19 pandemic. Findings demonstrated complexities regarding the use and uptake of VGCs, due to fluidity of definition, a lack of standardisation and issues regarding operationalisation in practice. Further research is yet to be conducted to better understand the role of VGCs in UK general practice.


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