'Remote first' GP appointments must be handled with care

As health secretary welcomes shift to phone consultations, experts warn that the change may not suit everyone

While the number of GP appointments overall dropped during lockdown, there was a clear shift towards remote consultations driven by the necessity of the Covid-19 outbreak. NHS figures show that 48% of 17m GP appointments in May were carried out over the telephone, compared with 14% of 25m in February.

This shift away from face-to-face meetings, according to the health secretary, Matt Hancock, on Thursday, was a development he was keen to maintain. “From now on, all consultations should be tele-consultations unless there’s a compelling clinical reason not to,” he said, adding that it was something that had been particularly welcomed in rural areas.

But experts say the shift to a “remote first” strategy for GP appointments should be undertaken with care.

Prof Martin Marshall, chair of the Royal College of GPs, said while the approach could be effective, particularly for simple conditions, face-to-face appointments remained important. “While there is a compelling case to retain some aspects of the different ways we’ve been working, we certainly do not want to see general practice become a totally remote service,” he said.

Marshall noted that physical examinations, blood tests and vaccinations could not be done remotely, that important visual clues may be lacking, and that some patients may not have access to the right technology.

“The biggest challenge is when patients have complex health needs. Being in the same room as a patient with whom you might have built up a relationship over time is incredibly useful and difficult to replicate remotely,” he said.

Edel Harris, chief executive of the learning disability charity Mencap, also raised concerns, noting that Hancock’s proposals could exacerbate health inequalities for people with learning disabilities.

The UK’s 1.5 million people with a learning disability should be offered face-to-face consultations automatically, without needing to ask for them,” she said. “This is a reasonable adjustment and we will be asking NHS England to ensure this happens – starting with annual health checks.”

NHS England has previously stressed the importance of security and confidentiality when it comes to remote services.

But remote consultations do appear to be popular. A survey by the British Medical Association on 1 June found 95% of GP respondents were providing remote consultations, and 88% wanted greater use of remote consultations to continue in future.

Marshall said that telephone appointments were convenient for many patients, and could improve access to care, including among people with mental health problems. They also require less travel, so are more environmentally friendly.

It remains to be seen if patients will welcome Hancock’s announcement. “We’ve already seen face-to-face appointments increasing, with a 40% increase over the last eight weeks, according to figures from our Research Surveillance Centre, while demand for telephone consultations has only risen 4%,” said Marshall, who has previously suggested a future with a 50-50 split between remote and face-to-face appointments.

Among those who have welcomed the shift to remote consultations is 32-year-old Emily Steer, an editor and writer in London. She said she had a couple of telephone consultations with her GP regarding Covid-19 symptoms and found them more thorough than during in-person appointments, with plenty of time to talk through issues. “I’ve never had such a positive experience with the NHS,” she said.


Nicola Davis

The GuardianTramp

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