Written by Abodunrin Aminu, Research Associate

The rapid shift to remote healthcare during the COVID-19 pandemic represented a significant change in NHS general practice in the last decade. Telephone, video and online consultations became the default where possible, offering a way to protect patients and staff while maintaining access to care. But did this shift affect everyone equally? 

A new study by our team published in BMC Medicine examines this question, using a platform that provides access to one of the largest health datasets in England (known as ‘OpenSAFELY’) which holds almost 19 million adult patient records from general practice services across the country. The research provides important insights into how remote consultations were used before and during the pandemic, and how patterns varied by age, gender, ethnicity and socioeconomic status.  

Between March 2019 and March 2022, the number of GP consultations delivered remotely tripled from around 10.1 million per year to over 32 million per year. That sharp rise reflects how rapidly practices adapted to new ways of working as lockdowns and social distancing became the norm.  

But the shift was not uniform across groups: 

• Before the pandemic, older adults (85+) were most likely to use remote consultations. Whilst during the pandemic, younger adults (18–49) became more likely to have remote appointments. 

• Men were consistently less likely to use remote consultation channels than women, both before and after the pandemic began.  

• Gaps in access between rich and poor persisted, with people living in more deprived areas less likely to use remote consultation services than those in more affluent areas.  

• Ethnic differences were also apparent, with people identifying as White where the most likely to have remote consultations compared with other ethnic groups across the study period.  

What this means for healthcare access 
The findings underline that digital transformation in healthcare while offering flexibility and convenience can also reproduce existing inequalities if not carefully implemented. 

For example: 

• Older adults may face barriers such as lower digital literacy or limited access to technology, making it harder to benefit from remote consultations even when they might be clinically appropriate.  

• Those living in deprived communities may experience poorer digital connectivity or have less stable internet access, compounding challenges in accessing remote services.  

• Gender and ethnicity differences suggest that remote consultation uptake is shaped by deeper social and cultural dynamics, not just technology access. 

Lessons for policy and practice 
As the NHS continues to promote digital first approaches to primary care, this research highlights a central challenge: to ensure that digital innovation does not widen health inequalities. 

Addressing disparities in remote consultation use will require a multifaceted approach. Potential actions might include: 

• Supporting digital inclusion through tailored training and assistance for older people and those less familiar with technology.  

• Ensuring broadband and device access in deprived areas.  

• Designing services flexibly so that patients who prefer or need face-to-face care can still receive it without disadvantage.  

• Monitoring how different groups use digital services and responding proactively to gaps.  

Looking ahead 
This study provides robust, population-level evidence about how remote consultation uptake varied during a period of intense change. It reminds us that technology alone does not guarantee equitable access and that health systems must consider the social determinants of digital health if the benefits of innovation are to reach everyone.

You can read more about our research in this area here

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