Professor Trish Greenhalgh Senior Research Fellow, Green Templeton College; Professor (Clinical) of Primary Care Health Sciences, Nuffield Department of Primary Care Health Sciences, University of Oxford.

The policy vision of remote consultations is of an efficient, safe and accessible remote service delivered through state-of-the art digital technologies and implemented via rational allocation criteria. The reality is less glamorous. Research reveals that in the real world, remote services involve multiple contradictions and tensions—for example, between quality and efficiency, or between infection control and patient choice—leading to ethical dilemmas for managers, support staff and clinicians. These dilemmas cannot be resolved by rigid standard operating procedures or algorithms: they require contextual judgement.