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General practice for all



It’s been more than a year since general practice introduced remote triage to keep patients and staff safe from Covid-19. I say ‘introduced’, but we’ve all been doing some form of triage for many years, whether remotely or face to face. Triage originated in the Napoleonic wars as a way to determine the gravity of wounds and prioritise treatment – today we use it to help patients quickly access the right treatment from the many healthcare professionals who now make up the general practice workforce.

Technology has supercharged the potential to do this. Online consultation tools enable patients to send a digital contact describing their symptoms, allowing the practice to triage the patient to the right person or service.
In January, we saw more than two million online consultation requests and 155,000 video consultations, as well as big increases in the use of electronic prescribing services. This shift hasn’t just offered safer care for patients and staff – it has allowed us all to work in different ways. Balancing home schooling or caring duties with work has become more manageable – if no easier – and for some, being able to offer an early telephone surgery before the school run has brought a new flexibility. These experiences will help us decide what to adopt more permanently and where to return to more traditional ways.

None of this takes away the importance of seeing patients in person; during the pandemic more than half of appointments have still been face to face. However, a recent Healthwatch report highlighted that the changes in access have been challenging for some, and we must ensure no one is excluded along the way. The Covid vaccination campaign has underlined the need to reach into our communities in a variety of ways; the experiences gained should
help us adapt access to local primary care, reflecting on what have we learned and what can we build on in partnership with patients and communities.

Last summer, a separate Healthwatch report – in conjunction with healthcare charity coalition National Voices – shed light on the patient experience of remote and virtual consultations. They heard that this is a convenient option for many people, who appreciate quicker and more efficient access and the ability to fit the appointment around their lives. Most respondents felt they received appropriate care and a majority said they would be happy with remote consultations and a blended approach in the future.

In-person collaboration is critical for staff too. Learning, development and teambuilding is hard to replicate remotely. A recent Kings Fund survey showed many GP trainees like the flexibility of remote working but want to be at the practice most of the time to ensure they feel part of the primary care team.

Recognising the different skills needed for remote working, our national clinical director for digital first primary care Dr Minal Bakhai worked with the RCGP to produce guidance on remote vs face to face. While general practice has proved its ability to transform, as our models evolve we must recognise one size does not fit all. Crucially, we must use the past year’s experiences to increase access and help close the health inequality gap. As a practising GP, supporting patients will always be at the heart of what I do – technology offers options but that connection between clinician and patient will remain a priority.

Dr Nikki Kanani is medical director for primary care at NHS England, and a GP in South London

READERS' COMMENTS [6]

Alan Woodall 13 May, 2021 4:33 pm

I have yet to see any published evidence in the peer-reviewed medical literature examining online triage/consultation showing non-inferiority over standard care (there is a modelling paper which suggests it may increase workload but no trials). I would be delighted to be proven wrong. Independent evaluation of safety to patients and clinicians, workload, ensuring it does not worsen health inequalities or affect clinician retention are essential.

I personally find it staggering that such a major change in practice has been rolled out without this confirmation. A new pharmaceutical would not be forced on the profession in such a manner. There are far too many companies (and some clinicians) with conflicts of interest to leave this in their hands. While I hope it works, there is a possibility this may have unintended consequences that are opposite of those desired.

Hello My name is 14 May, 2021 11:57 am

‘This shift hasn’t just offered safer care for patients and staff’ do you mean this year with Covid transmission risk? I certainly don’t think it’s safer going forward. Agree with recognition that total triage not all it’s cracked up to be,blended is better. But suspect I’m not alone in feeling just slightly ‘gaslighted’ – Hancock tells us one minute that all contact with go should be remote in first instance. Then all of a sudden we need to offer FTF to all. Which is it? Pray decide and let us know, before I lose the will…

Patrufini Duffy 14 May, 2021 2:19 pm

You can e-consult, text, email, video, phone, facey-facey, get dressed up, puppeteer, dance and do back flips all your SOP wants. Like it says it’s standard, not bespoke or unique. Lives don’t really matter, just the graphs, spreadsheets and data – that generic, grey, bland operating proecure. This won’t solve your deep cavernous UK and world (as they’re all invited too) complex health addiction issues that have been masterfully created, for a business and tariff model, by simply burning up the only staff you have left holding this crumble together. Pouring custard on it just makes it look sweet, but actually it’s all a bit soggy and weak. I like solutions. Not, more irresponsible anxiety. And fake empty empathy.
People aren’t getting healthier, you’re medicalising them to become mentally sicker. That is sick in its own right. You disempower them. They become irresponsible. They keep reaching out at a whim, like a child playing at toys. You’ve clearly missed the cake. Massively. But that is what juggernauts do, they bulldoze and make noise.

Samir Shah 14 May, 2021 3:58 pm

Agree with you 100%, Alan.
The main point here should be regardless of whether a GP needs to see a patient or speak to them or contact the patient by whatever, they should be enabled to practice their craft in the patient’s best interests. We spend yrs and yrs honing our skills to treat our patients.
If you are constantly being told how we should practice punitively, then you are deriding the essence of general practice (e.g. on the one side being told that Online consultation tools is the mecca of GP, then being told we must see patients (which we have been doing all through the pandemic) – both are wrong due to misinterpretation of the messages).
The best thing would be to allow practices to do what they do best without undermining the ability to do the job and meddling, for the sake of our patients.

Martin Jones 17 May, 2021 3:20 pm

I think we are making a big mistake using words like remote triage, in some respect PC was “lucky” that we had the elements partly in place to manage a Covid Pandemic, such as e consultation, video and telephone access.
However we must not conflate this with the ongoing devolvement of Primary Care teams, navigation and digital access.
We do not have enough GP’s to mange all the patient flow that is coming in our direction along with the work that is being pushed out of secondary care. And although its uncomfortable we have to recognize that we are operating in a world of 24 hour expectation and somehow we need to manage that.
I’d challenge anyone to say that every request that lands on my desk requires a GP, it all needs GP oversight but just like ED, when you walk through the door your not guaranteed to see a Dr/Consultant and nor should you be. Patients have the right to expect high quality timely care, but we must decide how to employ our limited resources.
We have some of the best Primary care in the World and I fully believe we are in the best position to be both the primary contact for patients and the team that manages their health care.
However in order to do this we need a sensible strategy that develops General Practice and that supports transfer of resource with activity. Above all we need to jointly manage patient expectations and not inflame public opinion.
I understand the pressure that Dr Kanani must be under, with the media running wild on perceived General Practice short comings but playing this out with unhelpful SOP’s and NHSE press releases helps no one.
Lets have an sensible conversation about where we need to go and how we jointly get there.
Dr Martin Jones
Pier Health
Westo Super Mare

Patrufini Duffy 17 May, 2021 4:06 pm

You cannot have a strategy for General Practice, when everything is free (to the world’s population), and customers are made to believe that they’re more powerful than staff and have a right to lay into you because of system failures and their addictive, hypochondriasis. There is a clear difference between the word person and patient, and not calling out time-wasting individual arrogance and irresponsible living is quite frankly going to kill this system off, or its staff. Even Amazon and Google would laugh at your empty promises and dubious outcomes. Free cake and ear syringing anyone?