Virtual or In-Person? Why Access Matters More Than the Mode of Delivery

Over the past few years, the discussion around telehealth has often been framed as a comparison. Is a virtual consultation as good as seeing a clinician in person? Can digital health replicate the quality of care traditionally delivered face-to-face?

These are valid questions. But perhaps they’re not the most important ones. Rather than focusing on which option is better, we should be asking something more fundamental: is care available in the first place?

Access Is the Priority, Not the Format

In many parts of the world, having any form of healthcare at all—whether in person or virtual—is still a privilege. Even within the UK, access can be uneven. For some patients, the idea of choosing between formats is a luxury. They simply want to be seen, heard, and helped.

Telehealth, remote healthcare, asynchronous messaging, and video consultations are not about replacing traditional care. They’re about expanding it. Increasing the number of ways people can receive care makes the system more inclusive, not less.

In my own research, which explored clinicians’ use of video consultations in community healthcare, a stark pattern emerged. At the height of the COVID-19 pandemic, telehealth use surged. Virtual consultations became the norm almost overnight. But that rapid expansion was followed by an equally rapid contraction. In some services, digital consultations dropped to zero.

This wasn’t driven by patient demand. Instead, many providers reverted to in-person consultations based on internal preference. The unintended result? Some patients—and even clinicians—were left with fewer options. For them, it wasn’t just about convenience or digital innovation. It was about whether they could access care at all.

Why Choice Still Matters in a Public Health System

The NHS Constitution enshrines patient choice as a fundamental right. Patients should be empowered to make informed decisions about their healthcare, including where and how they receive treatment (Department of Health and Social Care, 2023). But in practice, choice only exists if options are available.

If a person wants or needs a virtual consultation, and that option is quietly removed by a service, then that’s not a choice—it’s a barrier. Patient-centred care means acknowledging that access looks different for different people. Some might need face-to-face care for physical assessments. Others might depend on digital routes to overcome challenges like distance, disability, or inflexible work hours.

The Evidence in Favour of Virtual Care

The idea that face-to-face care is the gold standard for all patients and situations is not supported by evidence. Research continues to show that, when used appropriately, telehealth can be just as effective as in-person consultations for certain conditions. A review by Shigekawa et al. (2018) found no significant difference in clinical outcomes for chronic disease management between virtual and face-to-face visits.

Patient satisfaction is also consistently high. Kruse et al. (2017) conducted a systematic review which showed strong approval for telehealth, particularly in areas like mental health, follow-up appointments, and primary care consultations. Video and phone appointments can save time, reduce travel, and still build therapeutic relationships.

The shift to remote healthcare during the pandemic offered a glimpse of what’s possible. We saw that the system could adapt, and that patients responded well to the change. So why retreat from that progress?

The Risk of Losing Progress Made During the Pandemic

It’s understandable that many clinicians are more comfortable with face-to-face care. It’s what they know. And of course, some assessments and procedures can only be done in person. But a wholesale retreat from digital care risks undermining everything gained during the pandemic response.

In my study, I saw this first-hand. Some teams welcomed video consultations as a way to triage more effectively and offer flexible care. Others dismissed it as a temporary workaround. In the latter case, services simply stopped offering virtual options once lockdown restrictions lifted—even if patients had benefitted from them.

That kind of blanket approach ignores the diversity of patient needs. It risks excluding people who, for various reasons, found telehealth to be not just useful but essential.

A Place for Both Digital and In-Person Care

This is not about replacing one model with another. It’s about integration. Different patients need different things, and healthcare delivery should reflect that.

A person recovering from minor surgery might not need to physically visit a clinic to have a quick follow-up chat. Someone struggling with anxiety may feel more comfortable speaking to a clinician from the privacy of their home. Parents managing young children may find a scheduled video call far easier than navigating public transport and waiting rooms.

These are not hypothetical scenarios. They’re daily realities for many people. Digital tools allow services to adapt to those realities instead of forcing everyone into a single format.

Supporting Clinicians to Embrace Digital Healthcare

Adopting virtual care at scale doesn’t just require technology. It needs support, training, and cultural change. Clinicians need to feel confident that remote consultations are clinically safe, legally sound, and professionally endorsed.

Equally, patients need reassurance. They need to know that virtual care is a valid option—not second-best, not rushed, not a compromise, but part of the mainstream NHS offer.

Leadership at every level plays a role in making that happen. Investment in infrastructure must be matched by investment in education and engagement. Otherwise, we risk building systems that aren’t used or trusted.

Balancing Innovation with Inclusion

One concern often raised about digital health is the risk of digital exclusion. Not everyone has access to devices, data, or the digital literacy to navigate online systems. These are real challenges—but they are solvable.

The solution is not to abandon digital options altogether, but to design them better. Services should offer hybrid models and ensure that support is in place for those who need help getting online. Every patient journey should include a plan for those who prefer, or require, an alternative format.

Telehealth as a Core Part of the System

The real question isn’t whether telehealth is better than face-to-face care. It’s whether the system is willing to maintain and evolve the options that emerged in response to a crisis. Because when telehealth options are taken away, access disappears for some people entirely.

Virtual care has proven its value—during a global pandemic and beyond. It’s time we stopped treating it like an experiment and started treating it like what it is: an essential part of a modern, responsive, patient centred healthcare system.

In many cases, the best care is simply the care that’s available. Let’s not lose sight of that.