Face-to-face consultations are still the gold standard
Dr Irfan Malik, GP partner, Nottingham
The media and NHS England criticism triggered by the lack of face-to-face GP appointments has been harsh. However, I can see how it has developed. The protests of the patients became stronger and stronger. And while I’m sure that many GP surgeries continued to offer face-to-face assessments, I know this has been impossible in some places.
The move to ‘total triage’ was certainly appropriate at the time. And remote assessments have secured a place in the future of primary care.
But the face-to-face consultation remains the gold standard. And it is not just good for patients – it is important for us. Having worked in general practice for 25 years, predominantly seeing patients face to face, I haven’t really enjoyed the recent switch to remote consultations. What’s more, I fear that it will shorten my career due to a lack of job satisfaction.
The advantages of face-to-face consultations include: improved patient satisfaction; building and maintaining the doctor-patient relationship; reduction of barriers to care; better assessment of complex health needs; and picking up of softer cues and hidden agendas. In the longer run, seeing patients in person will actually reduce the number of contacts with the practice, and prevent a multitude of phone calls with various clinicians.
I also feel that total triage has made it harder to access care for patients with language difficulties, mental health issues, multiple morbidities and disabilities. A certain level of articulation is required for a patient to benefit fully from a phone consultation. Moreover, the reduction in face-to-face consultations has had an impact on GP training. Registrars have a reduced experience of seeing and examining patients. And then there are the missed or delayed diagnoses, including cancer, and safeguarding issues. No doubt there will be an increase in complaints and medicolegal cases as a result.
Most of all, the switch to total triage has been a public-relations disaster for general practice. GPs were perceived as becoming distant and less accessible. The locking of front doors and use of intercoms put up further barriers to the public. Many patients mistakenly assumed that we were closed. The gulf between GP services and patient expectations has never been wider, and high-profile media articles have inflamed this further.
Seeing patients face to face is important both for patients and GPs. We cannot let the digital revolution erode these benefits.
GPs are just doing what the Government advises
Dr Zishan Syed, GP partner in Kent and member of Kent LMC, the BMA and the GPC. He is writing in a personal capacity
GPs do not need to provide more face-to-face appointments because we are already providing an adequate number.
GPs have been doing precisely as requested of us by the contract through NHS England. During this pandemic, NHS England clearly directed us to change our way of practice, and to rely predominantly on a remote-consulting model. Former health secretary Matt Hancock made this absolutely clear, so there are no doubts regarding the matter. As time progressed, more was expected of GPs, in the form of delivering a mass vaccination programme at very short notice – which was very poorly resourced.
GPs have performed remarkably, but despite this, NHS England sought to appease certain sections of the media by sending a damaging letter signed by medical directors Dr Nikki Kanani and Ed Waller. The catastrophic result of that letter has led to numerous media outlets spouting a misinformed message about GP surgeries being shut. This is entirely false – our doors have always been open. What has changed is that face-to-face access is being limited to those with genuine clinical need through triage.
Challenge and change are never welcome. For the first time, the NHS is actively challenging patients about their desire, rather than clinical need. Because of the UK’s religion-like fanaticism towards the NHS, politicians have shied away from challenging patients’ expectations, to the detriment of the nation’s welfare.
GPs are highly trained professionals but politicians and the media do not respect our expertise. We have finite time during the day. If we now are expected to do more face-to-face work on top of what we are already contractually doing, we will burn out further, and this will be the end of general practice as we know it. I am alarmed by the numbers of GPs who are telling me that they wish to walk away from the NHS following the abuse they have received by the public regarding this false narrative.