The BMA and LMCs have issued fierce responses to NHS England’s order for GP practices to offer face-to-face appointments to all patients who ‘prefer’ one to remote consultation.
The BMA said NHS England’s letter, issued last night, was ‘tone deaf’ and comes as GPs want to see more patients face to face but cannot begin doing so ‘overnight’.
LMCs branded the letter ‘badly judged’ and ‘frankly ridiculous’, while grassroots GPs reacted in their droves to the announcement, as well as ‘inflammatory’ mainstream news coverage on the topic.
BMA GP Committee chair Dr Richard Vautrey said: ‘We need to be very clear, GP practices have continued to see patients in person during the pandemic, but as with many other NHS services, the number of face-to-face appointments has understandably had to reduce to protect patients – particularly those at higher risk if exposed to such a potentially lethal virus – and to protect our staff.
‘In the face of social distancing and infection control restrictions, practices should be commended, not condemned, for providing more than half of their appointments face-to-face. Even as restrictions ease, Covid is still circulating and new variants remain a concern, so to continue protecting patients, we have to limit how many can be in the surgery at any one time – something even NHS England note in its guidance. Sometimes this means a surgery waiting room with space for 40 patients can now hold only six, affecting the number of patients that can be physically seen each day.
‘The letter from NHS England is sadly completely tone deaf and rather than recognising the efforts GPs are making and the stress they are feeling as a result of the massive workload pressures they are currently experiencing, it has let them down and left them believing their efforts have gone unrecognised.
‘Most GPs chose family medicine because they recognise the benefit of longstanding relationships with patients and communities. They do not want to be call centre clinicians but do want to get back to seeing more of their patients face-to-face. But this cannot happen overnight and there must be honesty around the current state of play.’
Berkshire, Buckinghamshire and Oxfordshire LMC said that it was ‘angered by yet another communication from national NHS leaders which adds implicit fuel to the falsehood being promulgated in the media and elsewhere that GP practices are somehow “closed” to all face-to-face consultations or working at reduced capacity’.
Derbyshire LMC said in a statement: ‘LMCs across the country are currently discussing how badly judged and frankly ridiculous [NHS England’s] publication is. Hold your head high general practice and thank you for all your are doing.’
Leicestershire and Rutland LMC said: ‘We realise how shocked and disappointed that many of you will feel on reading this document, that was published without consulting with the BMA or GPC in advance.’
And it urged local GPs to ‘let the LMC know if you receive any increased complaints or abuse due to this document and associated publicity’.
Meanwhile, GP Survival chair Dr John Hughes the organisation is concerned the announcement ‘appears to have been made as a result of a press campaign suggesting that surgeries are closed’.
Below we have collected just some of the reaction to the face-to-face order:
Dr Ellen Welch, Doctors’ Association UK: ‘DAUK have been speaking out for months regarding the unsustainable workload pressures. Primary care is not coping with the current demand and this latest communication from NHSE will only worsen this and reinforce the anti-GP rhetoric.
‘We simply do not have enough resources to offer everyone who would like it a face-to-face appointment and surgeries should be able to utilise digital solutions at their discretion, to manage the demands of their own communities.’
Dr Ketan Bhatt, a GP partner in Watford: ‘A very political letter which absolutely everyone could have seen resulting in this kind to nonsense. There are really valid reasons as to why GPs are reluctant to let patients make decisions as to who they see and how – they do not know what is clinically appropriate a lot of the time.
‘That is why some practices did total triage in some areas. And with the advent of AHP/ARRS staff with varying degrees of clinical acumen – we need practices/PCNs deciding what is clinically appropriate more than ever. I’m afraid this letter was a bit of a kick in the teeth, playing to the tabloid narrative and damaging to any trust built up during this pandemic between NHSE and GPs. Once again, I say, are we really all in this together?’
A GP in South London who wished to remain anonymous: ‘It feels very undermining, as we have already had consultations about how we can safely increase our face-to-face consultations and to make more of these bookable by the patients.
‘For [NHS England] to insist on all contacts to be face-to-face seems foolish, as we are still spread thin due to needing to continue our vaccination programme. Moreover, from our telephone consultations, we rarely have anyone who was disappointed. This move by NHSE will not improve the demand – we can cover more ground by triaging first.’
A GP in Norfolk who wished to remain anonymous: ‘Not sure how much more I and we can take! Abysmal comms and I genuinely feel that this is designed to break primary’ care! Grieving for the job I love and trained to do.
‘I think this, is an attempt to damage primary care as we currently provide it, and the independent contractor model. Unfortunately I’m of the opinion that this then makes it easier for private companies to come in. I know that sounds rather paranoid, but I am genuinely fearful for where primary care is going to go.
‘We were told emphatically that we had to do doctor-first triage, and that we had to use online triage systems. We have done that, only to then be rebuked seemingly for doing that! The media narrative, which hasn’t been as strongly rebuked as I would have liked, was allowed to continue that in some way we were responsible for people not being seen face to face and that we were having a nice break, when in actual fact I and my colleagues have been working above capacity now for over a year. Now we are being “advised” that we should offer patients a face-to-face appointment if they want it.’
Dr Prakash Kachhala, a GP partner in Nottingham: ‘It’s another kick in the teeth for hardworking GPs. It’s another dent in morale. The comms from NHSE has been abysmal during this pandemic. GPs are hurt, upset. Some will quit after the pandemic, no doubt.’
Dr Kyle Roys, a GP partner in Bristol: ‘I feel so thoroughly that I’m not being represented. I’m a new partner and this feels like such an attack on primary care from our representatives – this can only contribute to recruitment/burnout problems. Secondary care using remote, waiting lists long, understand them – but attack primary care.
‘I would add that if any practices are truly not seeing people face-to-face, then they need to be contacted directly, not this public messaging across all our specialty. Those practices are likely struggling and need help, not public attack.’
Dr Dave Triska, a GP partner in Surrey: ‘I’m already experiencing the effects – having another media bomb dropped on us is not helping.’
Dr Siema Iqbal, GP in Manchester: ‘This is not mandatory. It’s not contractual. It’s an ask/guidance. So personally I would only do what is SAFE and SUSTAINABLE for your patients and staff. If you can do it safely, then do. Or stand your ground and do not put yourselves and others at risk of Covid or burnout.’
Dr Abbie Brooks, a GP partner in York: ‘For me, the main thing we need to consider nationally is that primary care was drowning pre-pandemic. At my practice, we were already trying to work out a safer and fairer way for our patients to access our care.
‘We have completely changed our model of care in the last six months (not due to the pandemic, was already in process) that helps us and the patient to reach the right clinician in the right timeframe.
‘We are a limited resource and need to use it wisely and effectively. Offering flexibility on appointment type is important – some patients prefer remote consulting due to work/childcare commitments, some prefer face-to-face.
‘We offer whatever the patient needs/wants following some form of triage, be it filling in a form online or by phone. We use the Klinik online system and it works well – the data we can gather is incredible.’