RCGP chair defends remote GP consultations amid coroner patient deaths concerns

The chair of the RCGP has defended GPs’ use of remote consultations during the pandemic, after a coroner’s report raised concerns over patient deaths.

According to a report from the senior coroner for Greater Manchester, widely covered in the media yesterday, seeing a GP face to face may have prevented five separate deaths.

The patients, who all received telephone GP consultations, might have received correct treatment more quickly if they had been examined in person, the coroner’s report had suggested.

But RCGP chair Professor Martin Marshall argued that the real issue in general practice is ‘not about face-to-face versus remote consultations, but about chronic GP shortages caused by more than a decade of under-investment’.

One patient highlighted in the coroner’s report, Maurice Leech, died in April 2020 after fracturing his femur. He was admitted to hospital after a fall, but the hospital did not carry out an X-ray of his femur and he was discharged. 

After still being in pain, Mr Leech was assessed by a GP over the phone. When the hospital finally found the fracture, he was no longer fit for surgery and died within two weeks. 

The coroner Alison Mutch found that a face-to-face GP appointment ‘would probably have resulted in Mr Leech being referred back to hospital at an earlier stage’, which may have prevented his death.

Another patient, Brian Mottram, died from Covid-19 pneumonitis in November 2020. After a phone consultation with his GP, he was prescribed antibiotics. He was found unconscious two days later.

Ms Mutch’s report deemed that a ‘face-to-face appointment and testing in such a scenario may well have led to identification of Covid-19 and different treatment’.

In two of the other cases, the coroner ruled that patients had not been able to effectively communicate the extent of their mental health issues, including anxiety and depression, in remote consultations.

But the RCGP’s Professor Marshall said media coverage of the coroner’s report was ‘contributing to a worrying narrative that has been gradually building up over the course of the pandemic: that remote consultations are substandard, harmful to patients and are being used by “lazy” GPs as an excuse for not seeing patents face to face in the surgery’.

He said: ‘As well as being inaccurate and untrue, this narrative in itself is harmful as it undermines public trust and confidence in remote consultations when thousands of patients are being assessed effectively and safely in this way in general practice every day – and have been since long before the pandemic. 

‘Patients are being led to believe that they haven’t had a “real” consultation unless they’ve seen their doctor in person and this can leave them feeling “fobbed off” or cause them unnecessary worry and distress that they haven’t been properly diagnosed.’

According to Professor Marshall, remote care ‘is not substandard, and GPs work incredibly hard to deliver the same high-quality, care for their patients, whether a consultation is remote or face to face’.

‘Another misconception is that remote consultations take less GP time, when many actually take longer.

‘The move to mainly remote consultations from the start of the pandemic was in line with government guidelines. It was necessary for infection control and to keep patients – and GP teams – as safe as possible. Face to face appointments and physical examinations have continued throughout, wherever clinically appropriate and safe to do so,’ he said.

‘Crucially, remote consultations have enabled GPs to carry on working, providing care and essential services to millions of patients at a time when other parts of the NHS had to shut down, and when many patients were reluctant to use the NHS for fear of catching the virus.’

Professor Marshall added that the ‘unexpected death of any patient receiving NHS care is always shocking and while we cannot comment on individual cases, our condolences go to anyone who has lost a loved one during the pandemic’.

It comes as a recent Pulse survey revealed that 50% of GPs say that a return to pre-pandemic numbers of face-to-face appointments would not be possible, and around 80% say that it is not necessary.

The survey also found that the majority of GPs – 57% – say that the flexibility afforded by doing remote consultations has benefited care overall.

However, some GPs expressed concern that remote consultations may be missing some diagnoses.

NHS Digital data for June shows that just over 15 million patients were seen face-to-face while 10.6 million had telephone appointments. 

There were also 161,689 home visits and 109,412 online consultations in June.

In March 2020, NHS England mandated a move to ‘total triage’ and, where possible, to remote instead of face-to-face consultations.

But in May 2021, NHS England issued guidance to practices which said GP patients must now be offered face-to-face appointments if that is their preference.

This led to widespread GP-bashing in the media, and headlines such as ‘GPs warned they must see patients face to face’ (The Daily Telegraph) and ‘GPs are ordered to see patients face-to-face amid fears vulnerable people are “having difficulty accessing doctors” during the pandemic’ (Mail Online).