Online GP appointments ‘must not become the default’ – GP leaders

Patients must be able to access both remote and face-to-face doctor appointments in a post-Covid world, the Royal College of GPs has said.

In a new report, general practice leaders said that while remote consultations should be an option, they must not become the “automatic default” for GP care.

It comes as new NHS planning guidance said a system of “total triage” must be embedded into general practice, despite the RCGP’s reservations.

During the pandemic, total triage was introduced, meaning that patients are remotely screened and directed to the most appropriate health service for their problem, while GP appointments are delivered remotely, by telephone, video or online, unless clinically appropriate.

Currently around half of consultations in general practice are being delivered face to face.

Before the pandemic, some 70% of appointments were face-to-face and 30% were phone, video or online; but this switched to around 30% face-to-face and 70% remote during the crisis.

The new RCGP study pointed to benefits of online and phone care, including offering patients convenience and flexibility, which may suit people who struggle to take time off work or housebound patients.

But it said remote consultations are better suited to more straightforward conditions or queries and where a physical examination is not required.

More complex conditions or those of a sensitive nature are better suited to face-to-face appointments, it said, adding: “In some cases, non-verbal or ‘soft’ cues such as signs of anxiety, self-harm,  or smelling alcohol on a patient’s breath, may be more easily missed remotely, or there may be concerns about a patient’s safeguarding, capacity or confidentiality.”

The report added: “Every patient is likely to sit somewhere along a spectrum between needing remote and face-to-face care, and this will change according to their needs at any particular time and as symptoms or circumstances change.”

The report warned that the long-term impact of greater use of remote care on the general practice workforce is currently unknown, with some GPs reporting “that remote consultations can often be exhausting, leading to ‘Zoom fatigue’.”

Some 63% of GPs in a poll said delivering all or mostly remote consultations reduced their job satisfaction and 61% said remote consultations are making the role more transactional.

Some 88% of GPs in the snap poll of 600 GPs also thought face-to-face consultations were important for building and maintaining trusting patient relationships.

The study said the extent to which patients really have a preference for remote care as the need for social distancing is lifted, is also unknown.

The College is calling on the Government to conduct a comprehensive review of total triage platforms and recognise it should not just become the default.

Professor Martin Marshall, chairman of the Royal College of GPs, said: “People choose to be GPs to care for patients, as a medical specialty one of our key tools is our ability to build doctor-patient relationships in order to deliver holistic care, and our members tell us face-to-face appointments are important for this.

“It is possible to build relationships via video or phone consultations, but it’s a very different skill to doing so in person, in a consultation room, which GPs have been trained for.

“GPs deserve credit for the remarkable way in which we swiftly transformed the way we deliver care in general practice once NHS England issued its pandemic guidance, both in terms of consulting remotely and implementing ‘total triage’ across the board.

“This was necessary so that we could continue delivering general practice services to patients whilst maintaining infection control in surgeries and keeping people safe.

“Remote consultations have advantages, particularly in terms of access and convenience for patients and making it easier for some hard to reach patient groups to access care.”

Prof Marshall said there is “certainly going to be a place” for remote in the future of general practice and IT investment is needed.

“But we know many patients prefer to see their GP face to face and that many GPs prefer consulting in person, as well,” he said.

“Furthermore, these new ways of working do not reduce GP workload – in fact, there is evidence to suggest triage results in an increase in consultation numbers and remote consultations can take longer.

“As we move out of the pandemic, it needs to be down to individual GP practices to be able to decide how they deliver services, based on their knowledge of their patient population.

“Ultimately, we want to be able to offer patients the choice as to how they want to access GP services based on their health needs.”

An NHS spokeswoman said: “General practice teams have continued to offer face-to-face appointments for patients throughout the pandemic – around 275 million appointments, with half of these taking place in person and more than half on the same or next day.

“Now that background rates of Covid have fallen and lockdown is easing, practices are expected to further ramp up face-to-face options so people get timely and appropriate care depending on need and preference.”