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NHS England orders GPs to offer face-to-face appointments to all patients


standard operating procedure


NHS England has issued new guidance to practices which says GP patients must now be offered face-to-face appointments if that is their preference.

In a letter to practices published last night, NHS England said practices should ‘respect preferences’ for face-to-face care ‘unless there are good clinical reasons to the contrary’, such as the patient displaying Covid symptoms.

Practices must also open their reception areas to walk-in patients, although these should continue to be triaged ‘as they would be via phone or via an online consultation system’.

It comes as the RCGP this week warned against retaining the ‘total triage’ model of general practice beyond the Covid-19 pandemic, arguing that it may ‘exacerbate health inequalities’.

The new letter said that ‘GP practices must all ensure they are offering face-to-face appointments’ and that both patients and clinicians should ‘have a choice of consultation mode’.

It added: ‘While the expanded use of video, online and telephone consultations can be maintained where patients find benefit from them, this should be done alongside a clear offer of appointments in person.

‘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, for example the presence of Covid symptoms.’

If conducting a remote consultation, GPs must be ‘confident that it will not have a negative impact on their ability to carry out the consultation effectively’, the letter said.

Meanwhile, NHS England said ‘all practice receptions should be open to patients’ to ensure no one is disadvantaged by a lack of digital access.

However, the letter said GP receptions ‘will not yet feel like they did pre-pandemic – for example where space is very constrained patients may be asked to queue outside’ and that social distancing and infection prevention and control guidance should still be followed.

It added: ‘Patients should be treated consistently regardless of mode of access. 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.’

Practices should also ‘engage’ with patients around access models and ‘actively adapt their processes as appropriate in response to feedback’, NHS England said.

It added that it is ‘asking CCGs to prioritise support to practices who are reporting very low levels of face to face appointments’.

An updated standard operating procedure will be published ‘shortly’ to replace previous guidance, as social distancing rules change from 17 May and services are ‘following and adapting accordingly’, the letter added.

But GP leaders have condemned the content and timing of the letter and urged NHS England to consider ‘retraction and apology to the profession’.

In an open letter to NHS England, chair of GP Survival Dr John Hughes said the grassroots organisation is concerned the announcement ‘appears to have been made as a result of a press campaign suggesting that surgeries are closed’.

He said: ‘We note that this guidance implies a kernel of truth to the allegations of closed surgeries and presume any implied support for these by Dr Kanani’s signature on this guidance to be an honest error. 

‘This guidance will not improve patient care, and indeed risks harm through increasing Covid transmission risk in surgeries (at a time when clusters of a new variant of concern appear to be on the rise this seems particularly risky) and reducing the GP workforce as a consequence of increasing an already extreme workload further.’

Dr Hughes added: ‘We further note that the new guidance was released without any consultation with the BMA, and that no such demands for hospitals to open up to patients on the basis of patient choice alone have been made.’

NHS England last month said that GPs should continue to triage patients remotely amid no plans for when the approach would end.

GP access previously caused controversy in the autumn amid suggestions that practices were not ‘open’ and ‘GP-bashing’ in the media.

In September, NHS England landed itself in hot water with a previous ‘reminder’ to practices to offer face-to-face consultations despite the ongoing pandemic and its own ‘total triage’ advice.

The health secretary has previously indicated that GPs should continue current levels of remote consulting after the pandemic.

READERS' COMMENTS [30]

Simon Plant 14 May, 2021 10:26 am

Seriously unhelpful advice. March was the busiest ever in the history of the NHS. Reports in the media that primary care is buckling under the pressure. We are offering F2F to the vulnerable and now risk patients with infection symptoms walking in to the surgery because it is their “right”. With the added pressure of a new Covid variant with possibly increased transmission potential. Seriously, dangerously unhelpful NHSE.

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Patrufini Duffy 14 May, 2021 11:31 am

I shouldn’t bother commenting much. Because this year has taught me categorically and irreversibly, to respect my own preferences. *You still haven’t learnt. And I would advise treading very carefully off that podium, with these letters you send out and the connotations you presume to the workforce that has kept people alive and safe, and you in your jobs.

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James Cuthbertson 14 May, 2021 12:12 pm

So now you’ll have hundreds of econsults to do AND a full F2F list. You’ll probably spend ages doing an econsult, and then see the patient 5 mins later for the same problem. They wont like what you say and will send another econsult!! Don’t forget hospitals are months behind and private consultants are so busy they’ll be dropping their NHS sessions soon!!! Kerching!

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Mr Marvellous 14 May, 2021 12:24 pm

The NHS England release is vague enough so that it doesn’t insist GPs see all patients F2F but patients will certainly think they have a right to do so. So – GPs shafted, but NHS England can avoid any blame.

And yes, the econsult unlimited workload GP is not being put back in the bottle.

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Andrew Jackson 14 May, 2021 12:39 pm

Can I reduce my appointment load to accommodate the additional time with a F2F to accommodate my wearing of PPE and room cleaning: of course I can’t: just a longer day again.
Very soon this Government will be in trouble over NHS waiting lists as staff availability is the limiting factor and there will be absolutely no thought given to the staff involved.
We are going to have a very difficult year and beyond

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terry sullivan 14 May, 2021 12:53 pm

orders? self employed contractors are ordered–jawohl mein fuhrer

time for gps to say no–stop the stockholm syndrome behavior and tell nhse what you are offering

dump bma–it will sell you out in exchange for gongs/preferment–as always

Subhash Chandra Bhatt 14 May, 2021 1:34 pm

Good old days are coming back when patient sees doctor if and when required. Triage was there before and will still be there.
I see no problem .
Just avoid seeing patient with covid symptoms .

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Peter Frost 14 May, 2021 2:38 pm

Nikki Kanani should resign. How could anyone who cares about the profession issue such a blatantly stupid and insensitive press release? Two of my own partners have just left to work in Australia – good luck to them.
I give up…….

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Joanna Rudnicka 14 May, 2021 2:55 pm

I think its Great news! Face to Face is always better in my opinion and yes, patients have every right to ask for one.

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Douglas Callow 14 May, 2021 3:02 pm

Joanna Rudnicka : so when they ask for a HV can they have that as well regardless of clinical need ?

Pradeep Bahalkar 14 May, 2021 3:22 pm

pt can have anything they want in our allocated session- of 4 hrs 10 minutes . Usually 3 hrs is dedicated clinical time. & remaining is admin time – so offer 18 slots of 10 minute each . After every face to face appt block 3 minutes for room cleaning and ppE changing. That leaves barely 13/ 14 slots for pts to see . If NHSE wants us to use some of that time to do e consults then take that time out of that 3 hrs as well which will further reduce number of patients we can see.
Its high time GP profession stands up to this nonsensical behaviour from NHSE & work to rule .

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Concerned GP 14 May, 2021 3:39 pm

Well said Douglas Callow!! NHSE are utterly useless and NK should step down. They have basically said that the bile filled media campaign against us was right and taken their side. What nobody is willing to say is that general practice is a FINITE resource and funded by the state so patients need to change their expectations and accept that they cannot have everything whenever they want. The pressures piled on GPs are enormous and NHSE have done NOTHING to support us. All they have done is added fuel to the fire and now patients will be banging on about their “right”’for face to face consultations not based on need but on what they want. Utterly ridiculous and pathetic – well done NHSE – you have outdone yourself this time!

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Richard Greenway 14 May, 2021 3:44 pm

Sorry wrong tone again Dr K,
Yet again highly trained professionals are being told to “do as they are told” without any gratitude. Of course we will (and are) seeing patients F2F, and by and large GPs prefer it. But we are repeatedly responding to prescriptive schemes which conflict and increase demand -more /less infection control for covid, more QOF, LES, more vaccinations, more online consults, more IA. Patients need reassuring that GPs are there for them – which we are.

We don’t need tabloid scare stories affirming. If you want to counter these stories -you need to be press savvy, get on the beeb and win the punters over, and keep the respect of the profession.

Patrufini Duffy 14 May, 2021 4:47 pm

NK + EWy – you do realise most of your GPs do not work privately – whilst most hospital Consultants do. They have revelled in this pandemic and GPs have fronted your vaccine programme so you can stand on a podium. You might want to re-think “your tone” – as Hancock once said that to another Doctor some time ago who stood on a podium – haven’t forgotten that.

Samir Shah 14 May, 2021 5:07 pm

Agree, Douglas Callow.
Regardless of whether a GP needs to see a patient or speak to them or contact the patient by whatever method they see fit, they should be allowed to practice their craft in the patient’s best interests.
We spend yrs and yrs honing our skills to treat our patients.
If you are constantly being told how we should practice punitively, then you are deriding the essence of general practice (e.g. on the one side being told that online consultation tools are the best thing since sliced bread, then being told we must see patients (which we have been doing all along)).
The best thing would be to allow practices to do what they do best without undermining the ability to do the job and constant meddling, for the sake of our patients.

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Jeremy Platt 14 May, 2021 5:39 pm

Yes Dr Sullivan – you’re right. I see nothing in this that can compel us – we do not have a contractual obligation to offer F2F.
And Dr Shah – absolutely, totally agree

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John Oldring 14 May, 2021 5:41 pm

I assume the same “must ” apply to secondary care who have horrendous waiting lists through no fault of their own -and are in breach of national guidelines for waiting times. At what point will the government agree to a meaningful independent audit of the state of the nhs pre covid and now .I wonder if there are grounds for safeguarding(with its legal implications ) concerns especially in secondary care of unintentional institutional neglect of patients due to horrendous waiting lists and delayed surgery
I do not know if there are grounds for a legal charge being brought -or do we just accept the situation that it will be the norm for more and more people to suffer and die through delays

Stephen Kell 14 May, 2021 6:23 pm

BMA reply not strong enough. We are open. Have been throughout.
In one non-contractual but very public letter General Practice is put back 10 years. The only way to deliver this is to introduce waits, which will quickly be 6-8 weeks.
Perhaps letters from GPs to consultants should now include a patient preference for face to face appointments.
If I had been asked to sign this letter I’d have resigned.
Completely demoralising. Clinically wrong. Politically naive.

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Nina Das 15 May, 2021 10:33 am

Feeling anxious about going back to the f2f 50-60 a day. I couldn’t cope then and was exhausted. How can we all stand up to this bullying not just by the media, patients and now nhse.?

MULAYIL KRISHNAN Gopinath 15 May, 2021 11:28 am

About time to. GP’s were never meant to be virtual doctors

Concerned GP 15 May, 2021 11:33 am

Add in some hospital colleagues to that list too Nina! There is an article by J Meirion Thomas in today’s Telegraph which further adds to the hostility towards us.

Andrew Fripp 15 May, 2021 11:40 am

I am certain our GP practice is no different to any other in having regular active discussions about the optimal balance of appointment types to deliver great care for our patients in a sustainable way. It is a complex balance involving geography, human resources, patient demographics, budget and patient expectations of normal practice, as well as infection control needs. We also balance the benefits of change against the cost of disruption to complex, established systems in which all of our staff and patients play a role.

This latest letter from NHSE follows the usual micro managing, ignorant and politically toady style of many previous letters from the same source and will be afforded the usual level of priority within our Practice discussions.

Thank you Nikki for reminding us that many patients would like to see a GP face to face.

David Church 15 May, 2021 1:47 pm

I have heard Covid can cause derangement of higher mental function:- it is obviously very prevalent in Government and higher NHSE management. Should they be called in for compulsory treatment in high-flow oxygen in an institution, perhaps?
They have obviously been saving up this stupidity through the whole of Purdah for this day!

George Forrest 15 May, 2021 3:31 pm

I am sharing this message from a GP colleague that was posted on a WhatsApp group yesterday evening because the real life consequences of the latest p***poor comms from NHSE are so serious – we will all need a plan in place before for Monday morning to try and prevent our staff suffering similar abuse as a direct result of NHSE’s astonishing incompetence and lack of support.

“on the back of today my reception being spat at and threatened with a knife due to the nhse letter I feel I have no option but to shut the doors for staff saftey. we had a line down the street also as patients demanding f2f (we have never stopped f2f after triage)”

John Glasspool 15 May, 2021 5:21 pm

Ignore anything from Merion-Thomas. He’s a tertiary care surgeon with expertise in one specific area yet certain parts of the media roll him out occasionally as an expert on GP services.
Also, ignore anything NHSE says. They’ll go away in time. Once the pandemic is declared over by the WHO, that’s when things can change.

Concerned GP 15 May, 2021 5:23 pm

That’s awful George but I’m afraid I’m not surprised because what exactly do people expect will happen given the rubbish coming out of the media and NHSE? The responsibility lies with them for this hostility and thuggery.

John Graham Munro 15 May, 2021 8:48 pm

REMEMBER——YOU WILL GET NO THANKS FOR WORKING YOURSELVES SILLY

Paul Cundy 15 May, 2021 10:29 pm

Unsuitable or offensive?
NHS England?
Yes.
but also add overstepping the mark and with no power to “order” GPs to do anything.

James Weems 17 May, 2021 5:19 pm

Thanks to John Hughes and GPS for having our back

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