This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

GPs should do 'all' consultations remotely going forward, says health secretary

Unless there is a 'compelling clinical reason' to see a patient face to face, all GP consultations should be carried out remotely going forward, health secretary Matt Hancock has said.

GP leaders warned that a predominantly remote GP service ‘wouldn’t be in anybody’s best interests long-term’ and should be 'approached with caution'.

In a speech on the ‘future of healthcare’ today, Mr Hancock said the Covid-19 pandemic has digitally transformed the NHS for the better.

In the four weeks leading up to 12 April, 71% of ‘routine’ GP consultations were delivered remotely, compared with about 26% face-to-face, Mr Hancock said.

This has ‘reversed’ compared with the same period last year, when 71% were face-to-face and 25% of patients were seen remotely, he added.

Mr Hancock said: ‘The feedback from this transformation has been hugely positive and especially valued by doctors in rural areas who say how it could save long travel times both for doctors and patients.

‘So from now on, all consultations should be teleconsultations unless there’s a compelling clinical reason not to.’

This will ‘free up clinicians to concentrate on what really matters’, he added.

He added that while there ‘always’ has to be an alternative system for people who can’t log on, we ‘shouldn’t patronise older people by saying they don’t do tech’.

He added: ‘Of course, if there’s an emergency, the NHS will be ready and waiting to see you in person just as it always has been.

‘But if they are able to, patients should get in contact first via the web or by calling in advance. That way, care is easier to manage and the NHS can deliver a much better service.’

Mr Hancock, who was speaknig at the Royal College of Physicians, added that making ‘Zoom medicine’ available is ‘key’ to moving forward after the pandemic.

He said: When the culture change came, things moved very fast and the key is that we don’t go back.

‘We do provide face-to-face where needed - whether that’s because you need a physical interaction to give the healthcare obviously or because someone doesn’t want to - but we also make available "Zoom" medicine.’

And moving to remote consultations long-term will lead to a ‘better service’ for those who need face-to-face treatment because it will ‘free up time’, Mr Hancock added.

It comes as data published today by NHS Digital showed that the numbers of GP appointments are continuing to rise to pre-lockdown levels.

In June, 21.3 million appointments are estimated to have been delivered in general practice - of which 53% took place with a GP.

And 61% of GP appointments were carried out by telephone, compared with 32% for other practice staff, the data show.

Dr Richard Vautrey, BMA GP committee chair, said the new statistics show the need to continue ‘triage arrangements’ and using remote consultations ‘where appropriate’ to keep both staff and patients 'as safe as possible'.

He said: ‘Practices are working incredibly hard not only to deal with the continued impact of Covid-19, but also to provide other routine services as well as they are able to.'

However, Dr Vautrey added that Mr Hancock’s vision for remote appointments by default ‘must be approached with caution’.

He said: ‘Physical appointments will always be a vital part of general practice and they continue to be necessary for many patients and the management of specific conditions, and we must not lose sight of that.’

And Professor Martin Marshall, chair of the Royal College of GPs, said the RCGP supports the greater use of technology post-pandemic ‘to an extent and as long as it is safe’. 

He added: ‘We should remember that the changes were made out of necessity - to keep our patients and our teams safe and to help stop the spread of Covid-19. While there is a compelling case to retain some aspects of the different ways we’ve been working, we certainly do not want to see general practice become a totally remote service.’

A ‘predominantly’ remote GP service ‘wouldn’t be in anybody’s best interests long-term’, Professor Marshall added.

He said: ‘Many patients ‘prefer seeing their GP in person and many GPs prefer this too, particularly for patients with complex health needs who really value the relationship-based care that GPs excel at delivering. 

‘We agree with Mr Hancock that it’s important we learn from how we have been working during the pandemic - and what we want to be able to do in general practice is offer patients a choice of how they access our services to best suit their health needs and preferences.’

A BMA survey last month found that nine in 10 GPs want to carry on delivering consultations remotely after the coronavirus pandemic has ended.

The chair of the RCGP has said that as many as half of GP consultations may be carried out remotely after the Covid-19 pandemic has passed.

During the pandemic, outpatient appointments have also taken place remotely, and this week, NHS England confirmed plans for patients to call ahead before attending A&E from this winter.

Pulse voluntary donation scheme

Since the outbreak of this pandemic, Pulse has strived to support you, whether it be through our resources page, our ‘Clinical Crises’ series, holding policymakers to account with exclusives such as practices being supplied with faulty masks, or GPs being told to stop routine services in the hardest hit areas.

However, good journalism cannot be done on the cheap and, like the whole publishing industry, we have been affected by the economic slowdown. We also strongly believe the content we produce should remain free as we feel it is essential for you. Because of this, we have set up a voluntary donation scheme. There is no compulsion whatsoever to donate. But if you feel we are helping you, and you would like to support us, anything you can spare would be greatly appreciated. Read more here.

Donate here

Readers' comments (80)

  • This will kill General Practice. Who wants to do ten years of training to spend 9hrs a day on the phone? I for one am already looking for a way out.

    Unsuitable or offensive? Report this comment

  • But it doesnt free us up,there is just more relentless meaning less sjit rolling down to the GP.Time to get out if you can.

    Unsuitable or offensive? Report this comment

  • So this moron is now a doctor???
    Worse than hunt, which I did not think was possible.....

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    ‘’ ‘So from now on, all consultations should be teleconsultations unless there’s a compelling clinical reason not to.’
    This will ‘free up clinicians to concentrate on what really matters’, he added.
    He added that while there ‘always’ has to be an alternative system for people who can’t log on, we ‘shouldn’t patronise older people by saying they don’t do tech’. ‘’

    You see , unless my English is that poor to understand this , the Health Secretary has serious problem in expressing in simple words what he meant to say ?
    Otherwise, this is old habit hard to rid again , One Size Fits All.
    OMG , mo wonder we are in this predicament under such leadership .

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Roboco*k , fo you know what the reality in general practice is ?

    Unsuitable or offensive? Report this comment

  • Compelling reasons to see patients face to face:
    No internet access for patient because it is too costly.
    No internet access for patient because the links to video consults are in English.
    No ability to read body language over the phone.
    Information filtered down the phone to a telephone interpreter is too limited.
    I cannot examine you over the phone.
    You need some human contact.
    The "doctor as drug" does not come into play over the phone.
    Spending 20 minutes on the phone (using the interpreter) then 20 minutes seeing you face to face (still using interpreter) beacuse of all of the above doubles the GP workload.
    Remote consultations are "doctor centric" dealing with your specific presenting problem when we all know that the hidden agenda "whilst I am here doctor" is usually the more important and a patient centred approach increases patient empowerment and leads to better outcomes.
    And a million more reasons why this increases health inequalities. Could we go for indirect discrimination on this one too?

    Unsuitable or offensive? Report this comment

  • I think that he is right. We do most of our consultations remotely and it is more efficient as many can be managed with a brief email/text conversation without phone or video without seeing the patient. That is where the savings are so that time to give to those that need it and that small number that need to be seen. It is not without problems and it is a shift in working practice but I think that we are good at learning new skills and adapting to change. I cannot see us returning to what was before.

    Unsuitable or offensive? Report this comment

  • 1. The contract allows us to deliver care in the way we see fit. If he wants this he will have to negotiate it with GPC, or impose it.
    2. He hasn’t stopped to see if it is more or less efficient, he has just assumed it is more efficient. The only good quality evidence out there suggests it is 8-30% less efficient (some you see anyway, some you have to call three times, phone calls are less efficient delivery mechanisms for complex care etc). So, you will have to increase funding or resources to deliver this, or watch the service deteriorate quickly and significantly.
    3. Many patients will hate it. I hope the MPs have lots of time to answer these letters as well as all the ones complaining about delays in secondary care delivery.
    4. It will open up the possibility of private GP services, and GPC should now push hard for this so we can do what the dentists did. Matt clearly wants a two-level service, and for our own sanity and health we should stop fighting it and stay planning for it.

    Unsuitable or offensive? Report this comment

  • I am practising remote pr exam; or is that what Hancock is doing to GP's?

    Unsuitable or offensive? Report this comment

  • Absolutely NOT what he said on a radio interview on LBC this morning which he ended with ‘ of course if a patient prefers to be seen face to face they will be’
    So punters will remain disappointed with this current service which has been decided as they way forward with NO patient input

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Seriously , I take the point that we definitely will keep this ‘new’ , different way for GP consultation. But to put the political narrative in such a fashion is misleading the public . Whether we will have a two-tier general practice system remains to be seen . I can see all kinds of political dialogues gate-crashing reflexively .
    At the mean time , the health secretary must define the meaning of ‘compelling clinical reason’ medico-legally .

    Unsuitable or offensive? Report this comment

  • Is not the guarantee of confidentiality not a ‘compelling clinical reason ‘ ?

    Unsuitable or offensive? Report this comment

  • Seems to be touting two diametrically opposed stories in the press today Mr Hand-cock depending on who you speak to .I think you have opened Pandora's box now and its going to be very difficult to shut.

    Unsuitable or offensive? Report this comment

  • Not seeing patients will "free up GP's to do what really matters". I presume that means filling in forms and ticking boxes? Or does he have something else in mind?

    Unsuitable or offensive? Report this comment

  • Dear PULSE

    Did Mr Hancock actually say;
    "GP's should do all consultations remotely going forward"
    Because if he did, his opinion is worrying and misguided but if he did not, are you guilty of promulgating fake news?

    Unsuitable or offensive? Report this comment

  • Isn't the risk of GMC referral [without the excuse of Covid-19 restrictions] the most compelling reason?

    Unsuitable or offensive? Report this comment

  • Here’s the thing, there will not be any changes other than GP doctors having to do telephone triages , and then filling into sessions . Patients are not dumb and will devise clever ways to getting a “clinical ground” to see a doctor. Regardless, I’ve started to prepare for my Canadian exams in earnest with the hope that global demand will drive up employment opportunities. If not, then perhaps geriatrics/radiology training would be second choice.

    Unsuitable or offensive? Report this comment

  • Hes already given patients the ammo they need to completely destroy his own plan. "unless they want to"

    Unsuitable or offensive? Report this comment

  • It’s a new speciality : ‘call centre medicine’....grim

    Unsuitable or offensive? Report this comment

  • When I was in practice I always went to the waiting room to call the next patient. The way they responded to being called and to my greeting, they way they walked down the corridor to my consulting room, gave me so much information about them and their problems.
    Remote consultation is prudent and arguably essential at this time, and will be with us from now on, but I wonder how much we will miss by not meeting patients face to face.

    Unsuitable or offensive? Report this comment

  • Some stuff can be sorted out remotely - but its very time consuming, and we're missing lots.

    So far I've seen severe anaemia, shingles, corneal ulcers, bowel cancer -all missed by repeat remote consultations -but would most likely been picked up F2F.

    Strangely that reassures me that we were actually doing something useful. This will happen when we can't examine, do blood tests or give empathy.

    Unsuitable or offensive? Report this comment

  • would have missed an apex of the head malignant melanoma with satellite lesions that pt couldnt see and thus unaware of. He tel consulted about a frontal lesion and I called him in F2F as he couldnt send photo. MM would have been totally missed with telephone only!
    .
    only 7% of communication is verbal.
    Telephone is easier with well known patients but quite hard with those never met and have no preexisting relationship.
    .
    MH is an IT Zealot without understanding the limitations. He really doesnt have any idea about primary care. Telephone consults take just as long/longer and quality of presentations much poorer as the trivia get easy access. Not fulfilling work at all.

    Unsuitable or offensive? Report this comment

  • The patients who will love video consultation will be the ‘busy’ professionals in the metropolitan bubble that Hancock lives in. The worried well etc. The elderly depressed , confused will not get a look in. Working patients can’t wait around all day for a call back while climbing scaffolding, milking cows , repairing roofs. Office workers might like it, but confidentiality is an issue.

    Internet speeds in rural area will not allow adequate video consultation. Non verbal cues missed entirely .
    I know GPs who think this is the way forward. They are deluded. Let’s assume 90% of consultations could be done remotely then the Government will manoeuvre GPs into call centre , most surgery buildings won’t be needed. Surgery owning partners had better hope they can sell their buildings as alternative use .
    Patients will be sent to large hubs , picked up, telemedicine usage etc.
    Pathology will be missed .
    Awful awful !

    Unsuitable or offensive? Report this comment

  • You can’t train new GPs by working like this.
    Medical Students learn huge amounts via F2F experience in primary care.
    Who would be a GP faced with a career of this.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    I think the truth here is :
    We are ‘too sensitive’ to what the health secretary!
    We have a code to serve and our Secretary of State is a politician .
    His speech might be misinterpreted but I am sure he did install an insurance that if a patient wanted a face to face , it would be provided .
    We had paid too much attention to what he said ,our bad !😈😆😂

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    We are ‘too sensitive’ to what the health secretary said !

    Unsuitable or offensive? Report this comment

  • I’ve been consulting remotely very effectively for the last four months. Here’s the crux of the matter though; I know my patients inside and out (often literally). They trust the voice at the end of the phone, because of many years of seeing said doctor.

    Unsuitable or offensive? Report this comment

  • BOJO and the Westminster clowns including Hancock have truly lost the run of themselves.Thankfully I am retired but am getting increasingly depressed with the Tory demolition of the once proud NHS. Perhaps they can replace GPs with robots.(? Any Daleks still about)

    Unsuitable or offensive? Report this comment

  • A remote consultation (video, phone, or econsult) can be anything really. Sometimes it’s entirely appropriate “just checking doc shall I take my Ace inhibitor first thing or later on” and saves the patient inconvenience and us time. But sometimes F2F is essential and not just for ultra acute stuff. But please, allow GPs the flexibility to choose a system that works for them and their patients and, god forbid, allows trust and continuity to develop.

    Unsuitable or offensive? Report this comment

  • I am not going back to the dark ages of standard pre- covid practice. Nothing wrong with remote assessment first. Bring them in if you think that need to. Good to hear someone in public eye continuing to challenge remaining rigid thinking and stereotypes

    Unsuitable or offensive? Report this comment

  • Patients are already demanding to be seen, even for trivial things because the hairdressers are open and why can't we see patients. It is more stressful over the phone or Accurx than seeing patients F2F. wondering whether it's worth the stress and working on alternatives currently because this is not sustainable for some

    Unsuitable or offensive? Report this comment

  • The compelling language - despite ignoring what range of access patients actually need, and ignoring the fact that we've been doing telephone consultations for decades- suggests to me that Hancock has a deal lined up with Livi. Like GP At Hand, competing for profitable patients. Nothing about patients, much about disaster capitalism.

    Unsuitable or offensive? Report this comment

  • Oh, and our IT has already become unstable with about ten api platforms. Bolt-on model is doomed, IMHO.

    Unsuitable or offensive? Report this comment

  • ‘So from now on, all consultations should be teleconsultations unless there’s a compelling clinical reason not to.’

    This will ‘free up clinicians to concentrate on what really matters’, he added.

    How and why does a video or phone consultation will free up time? The man is beyond contempt.

    Unsuitable or offensive? Report this comment

  • no explanation that in have seen so far is how you gain experience, how you pick up those whilst I am here essentials.
    Plainly many things can be managed non f2f and should be but for multi morbidity small children abdo pain breathlessness general tiredness etc I fear it is dangerous and often think at the end of an on line surgery that i am in danger of winging it.

    the agenda is being driven by those who like it and links with the behind the scene roll out of the new 111 with returner gps managing the triage and booking into your surgeries

    Unsuitable or offensive? Report this comment

  • Those GPs who believe they have been consulting adequately in the past few months via non-F2F need to be less hasty in their judgement. There is a time-lag before the things of import which have been missed/mis-evaluated become incontrovertibly exposed to the light of day and I would suggest re-judging matters in another 6 months time.

    Many GPs find themselves unable to read the notes as they should due to time pressures but this can be off-set a little by a quality F2F evaluation. If this too is absented then the quality of care provided is going to drop further. Meniscus medicine is what will result ie just the top layer of the most superficial evaluation will be provided. I reckon the medical defence bods will be watching matters closely.

    Unsuitable or offensive? Report this comment

  • It’s a good excuse not to provide or fund PPE.

    Unsuitable or offensive? Report this comment

  • Took Early Retirement

    71% of ‘routine’ GP consultations were delivered remotely, compared with about 26%. So where's the missing 3%. the numbers don't even add up for this clown.

    Unsuitable or offensive? Report this comment

  • Free up GP time, to basically take over social care. And get nailed for it.

    Unsuitable or offensive? Report this comment

  • He's even more of a clueless prat than I gave him credit for being.

    Unsuitable or offensive? Report this comment

  • Let common sense prevail

    You are wrong Mr Hancock. We may be able to deal with some of the whingers, whiners and needy by phone. But the practice of medicine still requires the laying on of hands. Do you want us to provide a service to those who need it, or to those who demand it (and shout the loudest).
    Reappraise your priorities, or risk destroying Primary Care, which remains the jewel in the crown of the NHS.

    Unsuitable or offensive? Report this comment

  • Well done Mr Hancock. A most sensible decision but most GPs are already doing it without the dictat. Screens out the dross. Prescription rates have dropped so much.

    Unsuitable or offensive? Report this comment

  • Hawkeye

    Call centre based abroad .....
    Sent to local hub if needed ,seen by nurse.
    A&E appointment only via call centre.
    Is this what they plan?
    RIP General Practice .

    Unsuitable or offensive? Report this comment

  • Speaking as retired GP who is now unfortunately a patient I find this awful. Over the last two months I have had five telephone appointments about three problems - none trivial - with five different doctors, none of whom had read why I had the appointment. All contacts were to be anytime in the day which meant I either had to sit by my landline or use my mobile and give personal medical details in the local supermarket. This is rubbish! Hancock should get back to what he's good at -playing Candy Crush. Donald Trump could do his job better. Any GP that thinks it is a good idea should clear out of medicine and work in a call centre frightening old ladies.

    Unsuitable or offensive? Report this comment

  • In 44 yrs of medicine I haven’t seen such a stupid comment by a politician about medical practice.(and I have seen a few).He has no clue about assessing patients and the dangers of triage even with most up to date technology.2

    Unsuitable or offensive? Report this comment

  • PS
    I wonder if the MDU and GMC would like to comment

    Unsuitable or offensive? Report this comment

  • Extremely worrying that this man is in charge of health care in the UK. This will be the end of NHS general Practice. It will be replaced by triage algorithms which will either lead to excess morbidity and mortality or overwhelm secondary care with unnecessary referrals. Thankfully I am near retirement.

    Unsuitable or offensive? Report this comment

  • As a patient I think it’s very good to consult remotely . You can tell the GP your life story and you don’t have to watch the GP body language , the subtle hints that time is ticking on , the nods and the ‘ ahh , I see’ that they teach medical students these days . You have freedom to direct the conversation and you don’t see the closing gambits - like picking up the prescription pad that tells you you’ve exceeded your notional 8 minutes ! 30 minutes pass very quickly .

    Unsuitable or offensive? Report this comment

  • I remember a 3/52 old with feeding problems. Mum had spoken to HVs twice, midwife twice and one of my partners once. I just said get in and lets look, stripped her off and pulse was uncountable. Turned out to be SVT at over 200. Granddad still sends me a bottle of scotch every Christmas even though I packed in five years ago. Sometimes you just have to examine your patients I am afraid.

    Unsuitable or offensive? Report this comment

  • Agree with Mr Hancock. Only now do I realise the amount of time I have wasted on pointless visits/appointments. This has allowed me to banish 10 minute F2F appointments for 15 mins. Agree there are dangers, but if managed well (by GPs not managers) then a more manageable job may result.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say