Transforming GP Training in the UK: The Lasting Impact of COVID-19 on Telehealth and Hybrid Care Models

Waseem Jerjes^*Azeem Majeed

• Imperial College London, London, United Kingdom

IntroductionThe COVID-19 pandemic not only marked a public health crisis but a turning point in the practice of medicine and medical education.1 While many sectors, including education, training, and business meetings, also moved rapidly online, no location felt this shift as starkly as general practice, where traditional in-person consultations were rapidly replaced by remote consultations.2,3 The shift came out of necessity, but as emergency measures were formalised into standard practice, it became clear that telehealth and blended care models would be central to future primary care.1,4 This overnight restructuring, as much as it was unavoidable, brought to light critical gaps in GP training, leaving trainee doctors to master new technologies and patterns of consultation without any structured framework to do so.The second step is to evolve out of reactive adaptation and develop a strategic, future-proof GP training system that integrates digital health, artificial intelligence (AI), and hybrid care in full, yet maintains the essence of patient-centred medicine.2,3 The outdated apprenticeship model of GP training based on observation and direct contact with patients is insufficient when virtual consultations, AI-assisted triage, and remote monitoring are becoming the new reality. GP trainees should not only be skilled in person-to-person medicine, but also on telehealth platforms, digital diagnosis, and ethical decision-making in an AI environment.This view point addresses how GP training must evolve to meet the needs of a hybrid healthcare system. It introduces the Hybrid GP Training Model, a structured method of blending digital and in-person learning so that trainees acquire skills to function proficiently in both settings. It will also address how AI is going to supplement GP training, the significance of interprofessional working, the global implications of telehealth training, and the ethical dilemmas of a digital-first healthcare system. It will then provide policy and education reform suggestions, suggesting a national telehealth competency framework and systematic digital literacy training for GP trainees.As general practice is at a turning point, the question is not so much whether telehealth and AI should be included in training as how to include it without losing the very essence of general practice. The question is how to build a new generation of GPs who are not only technologically proficient but who have undergone structured GP training to remain clinically competent, adaptable, and highly attuned to the humanity of medicine.Beyond Crisis Management: The Hybrid GP Model of TrainingThe emergency adoption of telehealth during the COVID-19 pandemic is over, yet its future role in daily practice needs a more structured, forward-thinking training solution.4,5,6 The challenge is now to ensure that GP trainees not only learn through experience, but learn systematically to deal with remote and face-to-face consultations with equal proficiency. We require a Hybrid GP Training Model that establishes telehealth as a core skill without forgetting that practical clinical skills should be central to medical training.The shift to digital-first care changed the manner in which GP trainees develop key skills. Table 1 summarises the core components of the Hybrid GP Training Model, highlighting the key training areas, the competencies required, and their purpose within a hybrid practice environment. In the past, training centred on face-to-face consultations, where judgment skills were developed through direct communication with patients, physical examination, and on-the-fly guidance.7,8 With virtual consultations now becoming the new reality, however, trainees were practicing in an environment where diagnostic clues were limited to a voice, facial expressions on a screen, or text in an e-consult. While these skills have since become essential, they have been acquired informally rather than through structured training, with inconsistent competency being the result.A Hybrid GP Training Model would establish specific learning outcomes and assessment criteria for telehealth so that trainees acquire the ability to provide remote consultations without losing the ability to transition to in-person care.9,10 Figure 1 illustrates the staged development of core competencies throughout the Hybrid GP Training Model, from foundational consultation skills to advanced digital equity and AI judgement. The model needs to include specific training in digital communication, remote environment decision-making, and systematic training on when an in-person examination is needed. Additionally, a Digital Readiness Index for GP trainees needs to be applied, evaluating the trainee's skill in telehealth tools, AI-assisted decision-making, and remote patient interaction.Where telehealth has brought increased access, it has also introduced new challenges, not least in patient relations.7 Physical absence is likely to lead to a more transactional style of interaction, where issues may be addressed economically but less sensitively. GP trainees should be trained to adapt consultation style to the remote context so that patient-centred care is not compromised in the interests of efficiency. A systematic hybrid approach to training would deal with the skills of working with the nuances of remote cues, the use of strategic questioning to compensate for the lack of physical examination, and building rapport in a remote context.Besides clinical ability, hybrid training should also address inequalities in healthcare caused by digital healthcare.6 Not all individuals are on the same level when it comes to access to technology, and some do not have digital skills, so remote consultations end up being a barrier rather than an enabler of care. GP trainees should be taught to be aware of these issues and use an equity approach to telehealth so that online consultations do not widen inequalities in accessing healthcare.Success with telehealth in the long-term within the context of primary care depends not on ongoing adjustment, but on active incorporation into GP training.10 By incorporating telehealth skills into curricula, developing structured blended learning opportunities, and assessing trainees on both digital and face-to-face care, the Hybrid GP Training Model provides a template for training GPs to meet a future in which technology enhances rather than replaces high-quality care.Telehealth Training and AI in Medical EducationThe integration of telehealth into GP training should be underpinned by systematic, evidence-based methods so that online consultations meet the same standard as consultations in person.11,12 However, traditional medical education has not kept pace with technological advances, so telehealth skills have been acquired by many GP trainees through experience and error. To fill this gap, artificial intelligence (AI) and digital simulation hold promising solutions, complementing telehealth training with immediate feedback, systematic assessment, and immersive environments.Among the most promising of the innovations is consultation training supported by AI, where AI tools review a trainee's actual consultation in real time, assessing communication skills, diagnostic accuracy, and decision-making. With immediate feedback on language, tone, and interaction with patients, AI tools can refine a trainee's ability to build rapport remotely as well as diagnostic accuracy.13 AI-supported platforms also hold the potential to simulate actual patient encounters so that trainees can practice remote history-taking and diagnostic thinking within a simulated environment prior to seeing actual patients.Besides AI-aided training, augmented reality and digital twins are the key to bridging the remote and on-site assessment.14,15 With augmented reality, remote observation and supervision of GP trainees is possible, with instant guidance in digital consultations. Meanwhile, digital twin technology, where a virtual representation of a patient is created based on real-time data, is likely to enable trainees to develop clinical reasoning on complex cases before actually seeing the patients. Such technologies could transform GP training so that it is not just convenient, but clinically effective.Despite these advantages, AI-aided training also presents ethical and practical issues that should be considered.15 One of the potential pitfalls is over-reliance on AI decision-support systems, where trainee GPs depend on machine suggestions without critically assessing independent clinical judgment. This could compromise diagnostic confidence and hinder uncertainty handling in the clinic—a key set of skills demanded of GPs. Additionally, AI models are as biased as the data on which they have been trained; if digital training tools are built on data that do not represent diverse groups of patients, then they risk reinforcing instead of alleviating disparities in care.For integration to be effective, AI should be used as a complement to education rather than a substitute for experience.12 AI literacy needs to be woven into training programs so that trainees learn to critically assess AI-driven findings and know its limitations. AI should not be viewed as a substitute for traditional learning, but rather as an additional tool that enhances decision-making and refines clinical judgment without losing the humanness of medicine.The telehealth training should be infused with the technological advances in a manner that is grounded in the core values of person-centred care. With the incorporation of AI-aided consultation feedback, augmented reality-enhanced learning, and digital simulations of patients, GP training can be revised so that remote consultations are as clinically sound and compassionate as face-to-face encounters.Interdisciplinary Collaboration: The Future of GP TrainingThe future of general practice is not merely about technical expertise; it is about working across disciplines to equip GP trainees with a broad set of skills relevant to modern primary care. The shift towards hybrid care models, AI-enabled consultations, and telehealth-delivered mental health care means GP trainees cannot be trained in isolation.16 For holistic competence, GP training needs to include learning alongside public health professionals, digital health specialists, and clinical psychologists.One of the areas where cooperation across disciplines is critical is mental health training in telehealth consultations.17,18,19 The pandemic has led to increased anxiety, depression, and post-traumatic stress disorder, so mental health is a growing part of daily general practice. Remote consultations, however, present certain challenges in the detection of distress, assessment of suicide risk, and effective psychological intervention. In collaboration with clinical psychologists, GP trainees should be formally trained in online mental health assessment, learning skills in detecting nuances of distress and using structured interviewing skills to overcome the lack of direct interaction. If not, telehealth is likely to be an inadequate substitute for mental health care in person, leaving vulnerable patients under-served.Besides mental well-being, it is essential to partner with digital health professionals so that GP trainees acquire the skills necessary in the rapidly expanding field of AI-aided diagnosis, wearable technologies, and digital literacies.17,18,19 With AI tools increasingly being applied to assist diagnosis and remote monitoring, GP trainees must learn how to integrate these technologies into practice without being too reliant on algorithmic recommendations. Digital health professionals will help trainees acquire key AI literacies so that they learn to interpret AI-derived insights without compromising on patient safety, ethics, and clinical judgment.Public health training is also a critical component of a future-proof GP training programme. The COVID-19 pandemic brought the role of primary care in crisis response into sharp focus, yet very few GP trainees were formally trained in pandemic preparedness, managing misinformation on health issues, and promoting community health resilience.19,20 The modern GP training programme should include dual learning with public health professionals so that the trainees acquire the skills to handle future crises, be it infectious diseases, climate-induced health threats, or mass casualty events. Coordinating public health interventions, handling vaccine hesitancy, and implementing rapid response measures should be a core component of GP training.Interprofessional working not only enhances clinical ability, but also changes the identity of the modern GP into digital navigators of health, mental first responders, and public health advocates on the frontline.18,20 Breaking down the traditional silos and combining co-training with psychologists, digital health professionals, and public health specialists allows GP education to break free of its conventional frames. It will not only make future GPs excellent clinicians, but also adaptable leaders in the complex healthcare landscape.