A group of influential MPs have urged NHS England to produce ‘clear guidance’ regarding face-to-face versus remote GP appointments.
It also said it is ‘not appropriate’ to set ‘a numerical target’ for the proportion of remote GP appointments.
The recommendations form part of the conclusion to the House of Commons Health and Social Care Committee’s inquiry into clearing the care backlog in the NHS in the wake of the Covid-19 pandemic.
They come as the Government had urged GPs to increase face-to-face consultations as part of the GP Access Fund measures launched in the autumn.
But, at the same time, GPs were also given contractual targets for promoting remote consultations to patients.
The committee concluded: ‘It is not appropriate to set a numerical target for the proportion of appointments carried out remotely in general practice.’
Instead, it recommended that ‘practices should respond to the needs of their local populations and work together with patients to establish the most fitting medium for their consultations based on clinical outcomes’.
Highlighting NHS England’s existing review into ‘digital tools’ in general practice, the MPs said this evaluation should be ‘published at the earliest opportunity’ and be used as a basis for ‘clear and consistent guidance’ for GPs.
The report recommended GPs should be given ‘best practice’ advice regarding ‘reducing bureaucracy’ as well as ‘the use of remote consultations’.
It said: ‘This should include guidance on how to approach conversations with patients about remote care, considering that while patients may not necessarily always be able to have a face-to-face appointment, they should have input into the decision and the rationale for any refusal should be transparent and consistent.’
Although there is no waiting list for GP services, evidence presented to the health committee by the RCGP suggested there could be 35 million ‘missed consultations’ waiting to be carried out as a result of the pandemic.
And the Department of Health and Social Care said in its submission that ‘deferred demand…. is significant, as people who may have been reluctant to visit their GP during the height of the pandemic are now returning’.
The health committee’s report noted that ‘general practice has actually seen increased demand resulting from the pandemic, with appointment numbers per working day for June 2021 2.8% higher than they were in June 2019 (excluding Covid-19 vaccination appointments), increasing from 1.19 million in June 2019 to 1.22 million in June 2021’.
And it said this comes while ‘GPs and their teams had delivered over 60% of all Covid-19 vaccinations to date, with long Covid and the treatment of patients with Covid-19 expected to place further demands on practices’.
Meanwhile, the committee said that it ‘appreciated’ the ‘candour’ of health secretary Sajid Javid, who when giving evidence to the inquiry, admitted the Government will fail to fulfil its election pledge to recruit 6,000 additional full-time equivalent GPs by 2025.
But the report added: ‘However, we remain concerned at the implications of this shortfall, not only in tackling the backlog but also for the sustainability of our current model of general practice.’
Committee chair Jeremy Hunt said: ‘The NHS faces an unquantifiable challenge in tackling a backlog of cases caused by the pandemic, with 5.8 million patients waiting for planned care and estimates that the figure could double by 2025.
‘However, our report finds that the Government’s recovery plans risk being thrown off course by an entirely predictable staffing crisis. The current wave of Omicron is exacerbating the problem, but we already had a serious staffing crisis, with a burnt-out workforce, 93,000 NHS vacancies and no sign of any plan to address this.
‘Far from tackling the backlog, the NHS will be able to deliver little more than day to day firefighting unless the Government wakes up to the scale of the staffing crisis facing the NHS, and urgently develops a long-term plan to fix the issue.’
The health committee report also urged NHS England to complete and publish evaluations of the ‘NHS 111 First’ pilots – where patients book slots in A&E via NHS 111 – to inform ‘future iterations of the service’, for which the MPs said they see ‘enormous potential’.
Responding to the report, the BMA said it was ‘pleased to read how the Health and Social Care Committee has dismissed numerical target-driven approaches, which include setting targets for remote and face-to-face GP appointments’.
Deputy council chair Dr David Wrigley said: ‘All doctors must be trusted to respond to individual patient need and not be driven by arbitrary bureaucracy.’
He added: ‘This wide-ranging and detailed report clearly lays out what a gargantuan challenge the NHS faces. The biggest barrier to tackling the backlog caused by the pandemic is a severe staffing crisis and our calls for improved workforce planning have thankfully been heard. It’s now time for the Government to listen too.’
RCGP chair Professor Martin Marshall said the College welcomes ‘the Committee’s recommendation that robust workforce plans must be developed to keep general practice, and in turn the rest of the NHS, sustainable for the future’.
In full: Health select committee recommendations on clearing GP care backlog
- It is not appropriate to set a numerical target for the proportion of appointments carried out remotely in general practice. Instead practices should respond to the needs of their local populations and work together with patients to establish the most fitting medium for their consultations based on clinical outcomes. Remote care is not for everyone, and it is essential to avoid unintended clinical consequences that may occur.
- NHS England has already commissioned an evaluation of the role of digital tools in primary care. We recommend that it publishes that evaluation at the earliest opportunity and uses it as a basis to produce clear and consistent guidance on best practice in:
- Reducing bureaucracy and day-to-day IT administration tasks, including those associated with referrals, routine blood tests, and follow-up appointments.
- The use of remote consultations in general practice. This should include guidance on how to approach conversations with patients about remote care, considering that while patients may not necessarily always be able to have a face-to-face appointment, they should have input into the decision and the rationale for any refusal should be transparent and consistent.
- We further recommend that NHS England looks beyond primary care in its assessment of the use of digital tools and considers the impact of an increased usage of such tools not only on patients, but also on other parts of the health and care system, especially at the primary care and secondary care interface.
Source: House of Commons Health and Social Care Committee
29 June 2022