Exclusive Around 80% of GPs say that a return to pre-pandemic levels of face-to-face appointments is not necessary, a Pulse survey has revealed.
Pulse’s survey of 1,000 GPs also found that half say that a return to the number of face-to-face appointments would not be possible, because patients are now expecting to have quicker access through remote consultations and fears around their health.
The survey also found that the majority of GPs – 57% – say that the flexibility afforded by doing remote consultations has benefited care overall.
GPs have been facing a barrage of negative media attention for being closed, but Pulse’s latest survey has revealed that GPs believe the increase in remote consultations have been of benefit to patient care.
The latest NHS Digital appointments data revealed that around 57% of appointments in July took place face to face, compared with 80% in July 2019.
However, the figures also revealed that around 28m consultations took place in primary care in July 2021 (including Covid vaccinations), compared with 27m in July 2019.
GPs responding to the survey said many appointments that took place face-to-face before the pandemic can easily be done remotely and believe that a proportion of remote appointments will be here to stay.
However, some expressed concern that remote consultations may be missing some diagnoses.
The survey also found:
- 61% of GPs say they are concerned about their health with the return to face-to-face appointments – including 21% who are ‘very concerned’.
- More than half of GPs say that they are back to ‘business as usual’ in terms of patients walking in off the street – but 27% say it won’t return to pre-pandemic levels ever, or within the forseeable future.
- More than one in five GPs are seeing patients face-to-face as the default, while 50% say that seeing patients face-to-face as the default won’t ever happen or not for the foreseeable future.
- Around 69% of GPs are doing home visits as pre-pandemic, while 65% of GPs are doing screenings as pre-pandemic.
In May, NHS England controversially urged GPs to offer all patients face-to-face appointments if that is their preference, and said receptions must be open for walk-ins.
But the BMA warned that many GP practices were ‘not yet safe’ for walk-in patients due to unsuitable reception areas.
Dr John Thompson, a GP partner from Greenock in Scotland, said that while a return to pre-pandemic levels of face-to-face appointments will be possible in future, ‘we may still wish to triage all face-to-face requests as many can be safely and effectively done by video, phone or email. This also stops appointments being booked for things which do not need a GP’s expertise or more minor self-limiting illness.’
He agreed that the flexibility afforded by doing remote consultations has benefited care, but added: ‘It doesn’t necessarily help with staff health as we all feel we can be reached by so many methods now that it’s difficult to close the floodgates. The horse has already bolted in healthcare with patient expectations.’
Dr Eithne MacRae, a GP partner from Merseyside, said that while ‘a lot’ of appointments can be done remotely, she ‘hated video consultations’ and so does ‘telephone and if face-to-face is needed they get face-to-face at surgery or a home visit depending on the situation’.
She added that the flexibility of doing online and phone appointments ‘helped greatly with access at the start’.
‘Some [patients] now resent having to come in when asked to do so. Patients seem to think eConsult means same day sorting and not triaging to book an appointment.’
One GP partner, who asked not to be named, said: ‘Due to increase in demand, phone triage is required first to ensure capacity to see those face-to-face that clinically require it. Undifferentiated face-to-face booking will overwhelm capacity and waits will be extremely long, leading to potentially unsafe care.’
Dr Richard Vautrey, BMA GP committee chair, said: ‘These survey findings underline how hard practices are working to meet the needs of people in their communities… but they also highlight how much they are struggling to do so given the constraints of a limited workforce, inadequate premises and the need to follow vital Covid-19 infection control measures.’
Professor Martin Marshall, Chair of the RCGP, said: ‘The adjustment to delivering a large proportion of appointments remotely during the pandemic has been necessary to stop the spread of the virus and keep patients and GP teams safe. It has meant that GPs have been able to carry on working when many other NHS services had to close down. Face to face appointments have also continued to be facilitated in a safe way, when clinically appropriate.
‘We know that many patients have benefited from receiving care remotely, and as a result found access to our services easier and more convenient, particularly for patients with mobility problems and younger people.
‘However, face to face consultations will always be an essential element of general practice, valued by both patients and GPs, and can be useful to pick up “soft signs” which can be helpful when making a diagnosis. Post-pandemic, the College is calling for a mix of consultation methods, based on a shared decision between GPs and their patients, based on GPs knowledge, and patients’ individual health needs.’
An NHS spokesperson said: ‘Every GP practice must provide face-to-face as well as telephone and online appointments and continuing to offer all of these methods of consultation is part of making primary care as accessible as possible.’
READERS' COMMENTS [8]
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The travesty lies where :
(1) Everyone , deep down , was conscious that Covid 19 has drastically changed our lives on earth in just 18 months . The ‘new normal’ has been the common narrative for a while but it begs the question , do we really understand and accept the reality ? Or the temptation of chasing after the ‘old world’ remains obstinate?
(2) As this longing for the old world continues , the expectation and demand of ‘back to normal’ persist but instead , we are ‘back to future’. The condemnation and smearing of GPs of not opening and not seeing patients face to face enough , epitomised this ‘those were the days’ mentality . Reality is a different story .
(3) Reality is GPs are sucking up all the workload left behind in the system and community plus delivering 75% Covid vaccination, as the government is very keen on more . As my honourable LMC secretary put , he had not heard any vaccination being given by remote access😳 , the logical argument is every Covid vaccination (plus flu now) is a face to face consultation😑.Remember the Pinnacle system adopted requires a list of questions as history taking before the actual jabbing . Then there is also 15 minutes of actual patient observation. The GPs involved , so often , had to attend immediately patients feeling unwell shortly after the vaccination. I certainly had many experiences of this kind . So my question is simple , if you want GPs to deliver more vaccinations , you have to cut us slack on ‘face to face from the old world’ because you just cannot have it all .
(4) The potential differences in opinion between JCVI and politicians are stark and the poor CMO is now the person in the limelight to call it , whether it is vaccinating all 12 years and above or third doses. Co-administration could be potentially a logistical nightmare, given the track record of the NHSE/I in deliveries.
(5) The likelihood is GPs still have to vaccinate at least some patients separately for flu and Covid boosters . Or else, some patients ended up having their flu vaccines in pharmacies and asking Covid booster from GPs . Once again , a mess .
Without face to face appointments we are rapidly becoming call centres !!
Comment above: really? Our triage is pretty far removed from that of call centre staff. If you are not delivering selected f2f where clinically appropriate why not? If you wish to see everybody f2f whilst infection rates are climbing, crack on. However, contributions such as yours exhibiting rigid monochromatic thinking are pretty unhelpful.
It seems the only people happy with telephone appointments are the GPs themselves. Not the patients, not the AE teams and not the hospitals. I think they are stuck in a bubble preferring a quick phone clinic as opposed to real active care. It has become GP self centered care as opposed to patient centered care.
And MBS do share with us your experience and knowledge of delivering front line General Practice!
You got slated whatever you do for being a darn good primary care expert, for free unlimited access.
MBS. When you do fined time to restructure your EMIS book, and deliver that extra 30 FF GP appointments per day, do let the profession know how that went, your renumeration and respect levels and ability to reduce demand.
MBS you seem to be unaware that hospitals are doing telephone calls instead of outpatients reviews. The majority of the clinic letters I read every day are generated from non face to face telephone reviews.
Most referrals in my local trust are now triaged first by a consultant via an econsult system so they can be remote managed if necessary. This is exactly what primary care are doing but that doesn’t fit your narrative does it.