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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.

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Readers' comments (80)

  • 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.

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  • 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.

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  • 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 !

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  • 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.

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  • 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 !😈😆😂

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  • Vinci Ho

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

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  • 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.

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  • 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)

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  • 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.

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  • 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

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