A letter from NHS England outlining an imminent update to the primary care standard operating procedure as COVID-19 restrictions continue to ease says half of all appointments in general practice since the pandemic have been delivered in person.
However, it adds that ‘all GP practices must ensure they are offering face-to-face appointments’. The letter then adds: ‘Patients and clinicians have a choice of consultation mode. Patients’ input into this choice should be sought and practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary, for example the presence of COVID symptoms’.
GP leaders have strongly condemned the statement – warning that practices are not contractually required to offer face-to-face appointments to patients irrespective of clinical need.
GPs have also warned the letter risks fuelling negative media coverage of access to general practice, and creating unrealistic expectations at a time when the profession is already struggling with unprecedented workload.
The letter also says that ‘all practice receptions should be open to patients’ to ensure that ‘patients who do not have easy access to phones or other devices are not disadvantaged in their ability to access care’. Where space is tight, patients ‘may be asked to queue outside’, the letter adds.
The drive to offer all patients face-to-face appointments marks a sharp about-turn from repeated statements from health and social care secretary Matt Hancock that more consultations should be carried out remotely.
Mr Hancock told MPs last November that he felt delivering 45% of GP consultations remotely felt ‘about right’ – and the health secretary has previously called for all GP consultations to be remote where appropriate.
Although GP practices have delivered large numbers of face-to-face consultations throughout the pandemic, in addition to a colossal number of face-to-face contacts through the COVID-19 vaccination programme, they have been operating a ‘total triage’ model in line with guidance from NHS England.
Although the latest letter has been reported in some national media as the end of total triage, it says: ‘Patients should be treated consistently regardless of mode of access. Ideally, a patient attending the practice reception should be triaged on the same basis as they would be via phone or via an online consultation system.’
Meanwhile, NHS England guidance earlier this year suggested NHS organisations should ‘continue to support practices to increase significantly the use of online consultations, as part of embedding total triage’ and suggested embedding total triage into the health service could be an ‘enduring legacy of the pandemic’.
The NHS England letter comes after an RCGP report earlier this week called for the majority of GP consultations to be carried out face-to-face after the pandemic.
Middlesex GP Nick Grundy told GPonline that GP practices such as his own had already been gradually increasing the range of cases they see face-to-face – but that practices were not contractually obliged to offer face-to-face appointments irrespective of clinical need.
He said demands for face-to-face appointments for all patients were ‘politically-motivated garbage’ that showed no ‘consideration of those doing the actual work on the ground’.
He said: ‘This self-evidently isn’t based on any clinical need, or the hospitals would be asked to do the same thing. They shouldn’t be asked to, of course, but neither should we. This is a politically-motivated stunt, nothing more.’
A response from Bedfordshire, Buckinghamshire and Hertfordshire LMCs warned: ‘GPs and their staff are exhausted and beyond breaking point. The constantly changing, contradictory and whimsical demands from system leaders has to stop and it has to stop now. Practices have to be trusted to deliver the care for their patients as they know best.’
— Matt Mayer (@alwaysthedutydr) May 14, 2021
Wessex LMCs chief executive Dr Nigel Watson said NHS England’s letter risked creating ‘unrealistic expectations’.
He said patients had been able to see GPs face-to-face throughout the pandemic and that NHS England’s focus should be on publicity to counter the false perception that general practice was ‘closed’.
‘General practice is working flat out,’ the Wessex LMCs chief executive said. ‘Workload pressure is higher than ever not least because of patient needs but the way practices have had to work. There needs to be realism about what we can manage coming out of the pandemic.’
GPs on social media have criticised a lack of consultation with the profession ahead of the NHS England letter – and Dr Watson called for a ‘more collaborative approach’ from NHS officials.