Visit your GP in person from MONDAY: NHS says all doctors must offer face-to-face consultations as well as phone and online appointments from May 17
- Measures would bring an end to ‘total triage’ system used during pandemic
- GPs can use phone and online consultations where patients benefit from them
- But physical appointments must also be available, letter from NHS bosses said
- Practice reception desks must now be open to patients in a Covid-safe manner
- So those who do not have access to phones or internet are not disadvantaged
All GP practices must offer face-to-face appointments and an in-person reception desk, NHS England bosses have said.
The measures would bring an end to the mandatory ‘total triage’ system introduced during the pandemic.
GPs can use telephone and online consultations where patients benefit from them but physical appointments must also be available from May 17, a letter sent out on Thursday said.
All practice reception desks must now be open to patients in a Covid-safe manner.
This is so those who do not have easy access to phones or the internet are not disadvantaged when accessing care.
It comes after plans to discourage face-to-face appointments in favour of patients having virtual consultations first even after the pandemic prompted were leaked.
Matt Hancock and health chiefs are keen to digitalise the NHS going forward – with critics branding the plans ‘not acceptable’.
More than 90million fewer face-to-face GP appointments were carried out last year, MailOnline can reveal.
NHS Digital statistics show 147.85million in-person consultations happened between April 2020 and this March — down from the 238.26million during the same 12-month spell the year before.
All GP practices must offer face-to-face appointments and an in-person reception desk, NHS England has said (file image)
More than 90million fewer face-to-face GP appointments were carried out last year, MailOnline can reveal
A letter from Dr Nikki Kanani, medical director for primary care at NHS England, and director of primary care Ed Waller told doctors patients’ preferences must be respected.
Due to Covid-19, GP appointments were conducted by telephone, video or online unless it was clinically necessary for a consultation to take place in person.
Currently around half of consultations in general practice are being delivered face to face.
Before the pandemic, some 70 per cent of appointments were face-to-face and 30 per cent were phone, video or online, but this switched to around 30 per cent face-to-face and 70 per cent remote at the height of the crisis.
In the letter, the leading medics stated ‘patients and clinicians have a choice of consultation mode’.
They added: ‘Patients’ input into this choice should be sought and practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary.’
Dr Kanani and Mr Waller cited the presence of Covid-19 symptoms as an example of a reason to refuse a face-to-face appointment.
‘Patients should be treated consistently regardless of mode of access,’ they said.
‘Ideally, a patient attending the practice reception should be triaged on the same basis as they would be via phone or via an online consultation system.’
Dr Kanani and Mr Waller added that to ensure receptions can open safely, patients might be asked to queue outside.
GPs can use telephone and online consultations where patients benefit from them but physical appointments must also be available from May 17, a letter sent out on Thursday said (file image)
The letter to GPs comes just two days after a report by the Royal College of General Practitioners (RCGP) heavily criticised plans to embed total triage into general practice post-pandemic.
The report noted that complex conditions – or those of a sensitive nature where a GP might need to pick up on non-verbal queues such as signs of anxiety or indicators of substance abuse – can be easily missed remotely.
Professor Martin Marshall, chairman of the RCGP, welcomed the news that the option of in-person services should be available to everyone.
He said: ‘This is good news and is what patients and GPs want to see. It removes ambiguity and we are particularly pleased that our calls for shared decision-making between GP and patient on the most appropriate method of consultation have been heard.
‘We now have a flexible approach decided upon by clinicians and their patients.’
Plans to discourage face-to-face appointments in favour of patients having virtual consultations first prompted anger after they were leaked yesterday.
Rachel Power, chief executive of the Patients Association, told MailOnline: ‘Access to general practice is clearly extremely difficult for patients at the moment.
‘The solution lies in ensuring patients get the care they need: it is not acceptable for the NHS to divert patients down routes that don’t work well simply to relieve pressure on the system – that’s not a solution.
‘Remote appointments, which in truth are mostly by phone rather than new online systems, should remain as an option for those who want them.
She added: ‘But face-to-face appointments with GPs must be restored as the default option.’
Dr Jeanette Dickson, president of the Royal College of Radiologists, told MailOnline the drop in face-to-face appointments has meant fewer people are being referred for cancer tests and treatments.
Facing backlash in the House of Commons today, senior Tory Jacob Rees-Mogg insisted patients who need face-to-face contact are ‘able to get it’.
Dr Dickson said: ‘Millions fewer people presenting to GPs has undoubtedly meant fewer people being referred for, tested and treated for cancer.
‘Polling revealed at the height of the pandemic last year, nearly half of patients in the UK with worrying symptoms did not contact their GP.
‘Oncologists have already seen the direct knock-on of the drops in GP cancer referrals, as thousands fewer patients were diagnosed with cancer last year than previously.
‘Remote GP triaging is a new experience for many patients, and GPs are working hard to ensure they can provide the same high quality of care and referral via virtual consultations.
‘Remote consultations are also not appropriate for everyone.
‘They may disadvantage some patients, for example, those with impaired hearing, who do not speak English as a first language or who experience digital poverty and problems with connectivity.
GPs are told to screen patients online or by telephone and discourage face-to-face appointments in latest NHS guidance
Patients should be remotely screened before being directed to the most appropriate health service for their problem, new NHS guidance says.
Doctors are being told the system of ‘total triage’ must be embedded into general practice, despite the Royal College of GPs’ reservations.
The method was brought in during the pandemic and sees a person checked by phone, video or online, unless clinically appropriate.
It comes despite the RCGP saying patients must be able to access both remote and face-to-face doctor appointments in a post-Covid world.
In a new report, general practice leaders said while remote consultations should be an option, they must not become the ‘automatic default’ for GP care.
Currently around half of consultations in general practice are being delivered face to face.
Before the pandemic, some 70 per cent of appointments were face-to-face and 30 per cent were phone, video or online; but this switched to around 30 per cent face-to-face and 70 per cent 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.
It added: ‘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 per cent of GPs in a poll said delivering all or mostly remote consultations reduced their job satisfaction and 61 per cent said remote consultations are making the role more transactional.
Some 88 per cent 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.
‘Again, GPs are working hard on the types of appointments they can offer and they can and should be able to accommodate patients face-to-face whenever necessary.’
Mr Rees-Mogg spoke in the Commons yesterday after a Conservative colleague raised issues her constituents were having getting an in-person consultation.
MP for Kensington, Felicity Buchan said: ‘Many of my constituents are telling me that they are finding it difficult to get face-to-face appointments with GPs.
‘Whilst I appreciate that telephone and video consultations will become a factor going forward as they are today, will [Mr Rees-Mogg] potentially give a statement to the House saying that face-to-face appointments should be available if they are needed and within a reasonable time frame?’
He replied: ‘General practice appointment levels are, I am glad to say, now close to pre-pandemic numbers.
‘In February 2021, an estimated 23.5million appointments were booked in general practices in England, an average of 1.19million per working day.’
Mr Rees-Mogg told MPs that ‘55.3 per cent of all appointments’ in February were face-to-face.
He added: ‘So people who need face-to-face appointments ought to be able to get them.’
The Royal College of GPs (RCGP) called for the idea of more remote consultations to be overhauled.
RCGP chair Professor Martin Marshall told MailOnline that while GPs switching to more remote appointments in the early days of the pandemic was necessary for safety, he did not want to see the trend continue after the crisis is over.
He said ‘the data shows how hard GPs are working, delivering a record number of patient consultations in March’.
The 28.4million came on top of taking a leading role in the Covid vaccination programme, with 75 per cent of vaccinations being administered in primary care.
Professor Marshall said: ‘Post-pandemic, the RCGP does not want to see general practice become a totally or even mostly remote service.
‘Face to face consulting is an essential part of general practice, and when is it safe, it needs to be down to GP practices to be able to decide, in partnership with their patients, how they deliver services.
‘Ideally, we want patients to have the choice as to how they want to access GP services based on their health needs and preferences.
‘GPs and our teams currently facing intense workload and workforce pressures, we urgently need Government and policymakers to address the unsustainable pressures facing general practice, to prevent GPs and our teams from burning out, so GPs can continue to deliver the care and services patients need.’
The RCGP said face-to-face visits are necessary for patients and doctors to build proper relationships and reduce ‘Zoom fatigue’ for GPs.
Mr Hancock started the drive towards virtual appointments last year, insisting to the Royal College of Physicians it would make life ‘quicker and easier’ for patients.
But politicians have warned general practice has been on the brink of collapse for years, with patients forced to wait two weeks for an appointment before Covid hit.
The problems have been exacerbated by GP practices closing across the country and a soaring population, with patients at surgeries rising by a third from 2018 to 2019..
Around 350,000 patients lost their GP after the closure of 100 surgeries during the same period.
Ministers have pledged to solve the recruitment issue. But GPs say not enough has been done to fix the problem.
GP guidance in January 2020 stated ‘primary care services via online consultations’ would be a key part of care moving forward.
After Covid struck, these were increased to around 90 per cent of all GP appointments, up from 75 per cent pre-pandemic.
Mr Hancock promised to return the NHS back to normal, pledging regular care would return in in April, before U-turning in July to announce all appointments would be digital first.
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