Will we ‘face-to-face’ the music?

It seems a lifetime ago that we were facing the arrival of Covid in the UK, and GP practices were grappling with the need to switch to remote triage.

Now, more than two years later, we’ve become accustomed to a list of phone calls where the face-to-face appointments used to be. Instead of a 30-to-70 phone to in-person ratio, most practices seem to be operating the reverse (for GP clinics, at least). But how is this impacting our patients?

This blog is, I’m afraid, going to consist of more questions than answers. For, try as I might, I find it impossible to find the data online to satisfy my ponderings. Perhaps if I keep asking, someone might do the studies.

How many times per year does the average UK patient consult their GP? And how does this compare with our European neighbours? Do we, as I suspect, have an increasing rate of ‘worried well’ consulting us ever more frequently? Reports have suggested that an increasing proportion of GP time is taken up seeing the most ‘regular callers’. What impact does this have on the rest of our patients (when GP numbers are so limited)? And how might we tackle it?

You know the patient. That name – seared on your memory from seeing it week after week, month after month. ‘Doctor, I’m worried I’ve found a lump in my neck’. ‘Doctor, I’ve been coughing, and I saw a speck of blood.’ ‘Doctor, there’s mucus mixed with my stools.’ Please don’t think I’m lacking compassion when I suggest that the dysfunctional relationship that so many patients have with the NHS is having a real and detrimental impact on public health. In a country with a nationwide (and increasing) shortage of GPs, how could it not?

So back to the title of this blog. Apparently, our patients are dissatisfied with the service they receive. The British Attitudes Survey found the greatest fall in satisfaction levels with the NHS in 25 years – most markedly with GPs. I’m convinced that it’s because we’ve switched to a remote model – patients feel alienated and distant from us, and unable to access care when they need it.

Working my way through my calls, I can see why. Take, for example, the musculoskeletal problem. In times gone by, I’d see a patient with a shoulder injury. I can (truth be told) never entirely fathom what exactly has gone on in these shoulders. But, generally speaking, they seem to respond well to pain relief, ice and gentle exercise. Nowadays, my response is to give the same advice, often peppered with the advice to self-refer to a physio. 

The truth is, in times gone by, a reassuring word (in person) from a GP kept many patients away from other services. A supportive chat might have avoided a mental health referral. A quick pelvic exam might reassure enough to avoid a gynae referral. Heaven knows the impact all the stiff shoulders that I’m signposting have on the physiotherapy service.

But having switched to remote triage, the floodgates have opened. Our patients can call from home or work, safe in the knowledge (if they can get through) that the GP will call them back. So, call they will. Our most frequent attenders need not even buy a bus ticket.

I have ongoing concerns about who’s getting through on the phones, and who’s receiving the precious face-to-face slots. I worry about the long-term impact of reduced incidental findings, about excessive antibiotic use and overprescribing.

Perhaps we don’t have the capacity to see everyone face to face. But could we, for example, offer all over-50s and under-fives a face-to-face appointment instead of a call, if they wished? If there was a time to do it, it will be this summer. It is, for once, an area where NHS England might be able to support us, in publicising the change and explaining the rationale.

I suspect that we’re duplicating care in phoning patients, then bringing them in. And diverting care from the elderly and more likely to be unwell. Perhaps it’s time I brushed up on my shoulder examination skills.

Dr Katie Musgrave is a newly-qualified GP in Devon and quality improvement fellow for the South West