More than half of GPs wish to establish remote consultations as the new first-line option after the pandemic, finds Nicola Merrifield
It’s been nine months since GPs rapidly adapted to remote working, an approach necessitated by the coronavirus pandemic.
But this style of consultation may well become a permanent feature in general practice – and GPs are backing it, despite concerns that diagnoses may be missed.
Health secretary Matt Hancock’s preference for digital appointments is well known. He said last summer that ‘all’ future consultations should be remote if there was no compelling clinical reason for a face-to-face appointment.
Last November, he told MPs in the House of Commons that ‘around 45%’ of primary care appointments were at that point being carried out via telemedicine, which ‘feels about right’ going forward.
And – perhaps surprisingly – many GPs now also want this approach to become permanent. A new Pulse survey of more than 850 UK GPs found 55% want GP consultations to continue to be remote by ‘default’ after the pandemic.
GPs who support the move say triaging over the phone first, rather than having an open-door policy, is advantageous in terms of workload. Patients who then need to be brought in can be seen more quickly, they say.
But they stress face-to-face appointments should always be available.
Maidstone GP partner Dr Zishan Syed says: ‘Remote consultation is appropriate to fight back against the ridiculous demands made on general practice pre-Covid. People will have to learn they can’t see a doctor at the drop of a hat and need to accept triage.’
Another GP partner, Dr Maria Carrasco, says her south London practice will maintain a ‘needs-first’ rather than a patient-driven model: ‘I like seeing my patients but there’s only one of me and a remote triage system means I have control over what needs to be seen in surgery today and what could wait.’
Patients are not protesting about the lack of face-to-face access in large numbers either. Pulse’s survey reveals GPs on average receive just three complaints a month about the policy of offering a remote appointment first.
A GP based in Cumbria, who asked to remain anonymous, says it is crucial to clarify that in-person appointments are still an option: ‘There has been some moaning but it’s fine as soon as they realise that, if appropriate and required, they will be offered a face-to-face appointment.’
GPs, though, are cognisant that remote consulting has safety issues.
Around 45% of GPs responding to Pulse’s survey said misdiagnosis during the pandemic had been a ‘big’ (39%) or ‘significant’ (6%) concern.
GPs have reported missing serious cases because physical examination came later. One, who asked to remain anonymous, says: ‘We have a patient in their thirties with probable sarcoma, which took several months to diagnose.
‘We have discussed it as a significant event and all clinicians involved felt in normal times the patient might have been examined a lot sooner, which may or may not have led to a quicker diagnosis.’
Another voiced concern about elderly patients who ‘tend to downplay symptoms when they are often very unwell’.
The Medical Defence Union is also worried about the implications of remote appointments, following a rise in complaints and adverse event claims during the pandemic.
A recent small survey of GPs by the MDU found the majority plan to continue with remote consultations and triage, echoing Pulse’s findings.
MDU head of advisory services Dr Caroline Fryar says: ‘It is becoming clear that working practices in the NHS have irrevocably changed as a result of the pandemic. In some instances, this has brought positive changes such as remote consultations improving flexibility and convenience for patients with, as a consequence, fewer missed appointments.
‘However, the pandemic has also led to delays in referrals and increased waiting times, and it’s clear GPs are also concerned about the risk of a future complaint or claim for treatment undertaken during the pandemic.’
READERS' COMMENTS [3]
Please note, only GPs are permitted to add comments to articles
I can’t for Ed Waller to contractually enforce a 64% use of F-F consultations in 2021/22. Then make us audit it.
I’d be interested to hear how you’ve all found video consulting.
Personally I think it’s worse then telephone consulting –
1. Patients sometimes unable to log on or unable to get audio working
2. “Poor reception” problems generally worse with video call than with phone call
3. Audio delay worse with video than phone call causing doctor and patient to keep speaking at the same time – a “rapport killer!”
And the video is rarely good enough to be clinically useful. A photo sent by text is generally better.
whilst i think maintaining the option for remote consultations would be helpful there is no doubt at all in my mind that it increases the potential for misdiagnosis and unfortunate delay. like everything its ok when used appropriately but there will always be the potential for its misuse particularly in the ongoing climate of chronic underfunding and over worked GPs. My fear is in time it will create a perception of ‘space’ in primary care that will inevitably be filled in time with the transfer and addition of ‘other duties’ from secondary care. we were overwhelmed before Covid because the NHS could just about get away with it..ive no doubt we will be again whatever model is in place, and the danger we face is being left with a model that dramatically increases risk – risk that will be solely carried by primary care.. no one else. its a move prompted by a crisis and we should be aware of the risks inherent in letting it become too much of the “new normal “. most of the errors are yet to show themselves..medical negligence cases have a nasty habit of playing out slowly and you frequently get the letter from the lawyer many months after the event..most of the unfortunate few wont have received their letters yet