Table 3.

Overview of policy approaches to video consulting across the four nations, before and during the COVID-19 pandemic.

	England	Scotland	Wales	Northern Ireland
Pre-pandemic policy and infrastructure	Longstanding concern with new technology as a means of generating efficiencies, with impetus for innovation-driven change in health care, including video and e-consulting; early adoption of platforms in some settings; evolving but limited infrastructure	Longstanding policy vision and support for technology-enabled care and allied infrastructure, including Near Me, national video consulting service; significant impetus from cross-government agenda to reduce carbon emissions	Policy push for technology-enabled care, including video consulting; with support for local pilots, regional spread then national roll out, but limited/varied infrastructure	Policy supporting virtual consulting largely oriented to phone consulting; ambition for digital health, with video consulting evolving via small quality improvement programs; digital infrastructure limited with widespread absence of broadband
How the immediate crisis response was framed in relation to digital technology	An opportunity to innovate—to accelerate set up and spread of novel forms of remote consulting across the NHS, thereby achieving the policy goal of “remote by default”	An opportunity to scale-up—building on established infrastructure, to extend and learn from existing models of technology-enabled care, bringing all parts of the country to the level of exemplar sites	An opportunity to become known as a national digital innovator—to build national video consulting service and gain political and health system currency	A window on challenges—revealing gaps in infrastructure and digital readiness, as well as dilemmas about how to organize and deliver care at time of crisis
Policy and regulatory shifts during the pandemic	Centralized procurement, slackening regulation, relaxed information governance; fast-track research into remote consulting	Centralized procurement, slackening regulation, relaxed information governance; rapid evaluation and learning	Centralized procurement, slackening regulation, relaxed information governance	Slackening regulation, relaxed information governance, rapid quality improvement set up
Approach to technology supply during the pandemic	Mixed approach, with central contract to single supplier (Attend Anywhere) for secondary care, combined with encouraging other suppliers in to the wider NHS who met minimal standards and could deliver a usable product at speed	Extension of existing contract to single supplier of video consulting platform (Attend Anywhere) in strongly-branded national program (Near Me)	Mixed approach, seeking to learn from, and emulate, Scotland's success with a single national supplier while also recognizing multiple suppliers	Continued arrangements with existing multiple suppliers, with interest in learning from Scotland's success with a single national supplier
Approach to spread and scale up of video consulting during the pandemic	Rapid roll-out and implementation of innovative technologies, central support and guidance, varied procurement (e.g., locally driven in primary care, centrally steered in secondary care)	Extension of successful models of good practice using principles of quality improvement—with facilitated adoption, central support, training and guidance, and system learning	Rapid roll-out and implementation, central support and guidance, central procurement	Continued emphasis on virtual consulting with extended use of existing video platforms supported via evolving quality improvement program
Key sources of learning for national roll-out	Cross-national peers (esp. Near Me in Scotland), on-going research and evaluation, NHS data and provider feedback, industry/tech suppliers	Dedicated quality improvement cycle, involving collaboration among service leaders, capturing data in a “learning health system” model and external evaluation; sharing learning with cross-national peers	Cross-national peers (esp. Near Me service in Scotland), in-house evaluation, provider feedback	Predominantly in-house quality improvement and provider feedback, plus external input from peers in other nations (esp Near Me service in Scotland)
Adoption and use of video consulting	Wide variation by setting and specialty. Very little sustained uptake in primary care	Substantial national adoption overall, though used significantly less in primary care	Wide variation by setting and specialty. Very little sustained uptake in primary care	Wide variation by setting and specialty. Limited uptake in primary care
Longer term policy focus	Promote innovation-driven new service models, support supplier diversity, address digital exclusion, generate patient-led demand and extend video consulting services	Routinize Near Me service, ensure solid infrastructure, support patients and professionals, address health/digital inequality, evaluate and share learning; achieve carbon reduction goals	Extend national video consulting service, address digital exclusion, develop and support infrastructure	Refine and implement policy on digital health, develop digital infrastructure including strengthening broadband coverage, grow quality improvement collaborative on video consulting