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General practice has always been the foundation and gateway to the NHS, but this part of the healthcare system is now under strain due to greater demand from an increasingly complex patient profile, and a stretched workforce. Lack of staff and coherent planning means that the current model is not fit for purpose, and this has resulted in a recent decrease in patient satisfaction. This proposal by the think tank Policy Exchange outlines the reforms that could help the NHS develop a model of general practice to better meet the needs and interests of patients and healthcare workers.

Hughes et al. studied video consulting in the NHS during 2020–2021 through video interviews, an online survey and online discussions with people who had provided and participated in such consultations. Video consulting had previously been used for selected groups in limited settings in the UK. The pandemic created a seismic shift in the context for remote consulting, in which video transformed from a niche technology typically introduced by individual clinicians committed to innovation and quality improvement to offering what many felt was the only safe way to deliver certain types of healthcare. A new practice emerged: a co-constitution of technology and healthcare made possible by new configurations of equipment, connectivity and physical spaces. Despite heterogeneous service settings and previous experiences of video consulting, we found certain kinds of common changes had made video consulting possible. The authors used practice theory to analyse these changes, interpreting the commonalities found in our data as changes in purpose, material arrangements and a relaxing of rules about security, confidentiality and location of consultations.

Fewer than 1% of UK general practice consultations occur by video. This study by Trisha Greenhalgh and colleagues aims to explain why video consultations are not more widely used in general practice.