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How a pandemic changed the face of general practice

By 21/12/2020No Comments

The past year has had a huge impact on all parts of society, not least the NHS. In particular it has seen a massive shift in the way general practice – and also many outpatient departments – provide care to their patients.

Back in March, almost overnight practices switched from providing predominantly face-to-face appointments to total triage. Backed with funding and roll-out support from NHS England every practice was also provided with access to online consultation systems.

Data from the RCGP’s research and surveillance centre shows how practices deliver care has changed across the year.

As the chart shows by far the biggest change has been the switch from face-to-face to more telephone consultations. The number of online or video consultations has increased but they still remain a small amount of the overall interactions GPs and other clinicians have with patients.

This switch to new ways of consulting has not been without problems and challenges. Perhaps the most striking of these happened in September when a letter from NHS England reminding practices of their responsibility to provide face-to-face appointments was press released to the media ahead of it being sent to GPs.

The ensuing negative media coverage caused a furore. GPs branded the letter ‘offensive’ and many reported increasing numbers of complaints and abuse directed towards staff following the news reports.

NHS England primary care medical director Dr Nikki Kanani was quick to apologise but by then the damage had been done, with many GPs feeling that they had been unfairly singled out for criticism when the majority had been working harder than ever.

In fact, shortly after it sent the letter, NHS England’s own data showed that GPs and their teams delivered 26.65m appointments in September – more than at any point since January 2020. The figures from NHS Digital also showed that in September practices provided the highest proportion of appointments face-to-face since March, with 56.6% of appointments being undertaken in person.

So what happens now?

Indeed looking at the chart above it’s clear that the switch to more remote consultations has not cut workload at all. Consultation levels in recent weeks are amongst the highest they have been all year.

While the number of face to face appointments have significantly increased from their lowest point at the height of the first UK-wide lockdown, it is unlikely the proportion of consultation conducted in-person will ever return to the levels seen before the pandemic. Remote consultations are undoubtedly here to stay.

For some patients they are simply more convenient and many problems can be handled just as well on the phone. But clearly for many patients – and GPs themselves – face-to-face care remains a vital part of general practice.

In July GPonline looked at what the profession thought about the future of GP consultations and new technology introduced since the pandemic started.

More than 40% of GP partners responding to our poll believed that around 50% of consultations would be face-to-face in future, with only 3.6% thinking things would go back to pre-pandemic levels where around 80% of consultations happened in-person.

Patient relationships

However, the impact of this shift to remote consultations is being felt by many GPs. A second GPonline poll later in November found that more than two fifths of GPs believed their relationship with patients has worsened because of changes to the way practices were asked to operate during the pandemic.

There is also concern about ‘digital exclusion’, which could mean vulnerable patients, such as the elderly, those with dementia or hearing loss or people from the most deprived backgrounds, could struggle to access digital healthcare services.

In our November poll one GP said: ‘There has been difficulty building relationships with new or less well-known patients. Also decreased continuity, reduced levels of trust and an increased sense among patients that they are being “fobbed off”.

‘There is also concern about how less technologically able patients are being sidelined. More elderly people or patients with learning difficulties are being dealt with via third parties, or maybe not consulting at all.’

Other doctors, however, argued that increased use of remote consulting had provided tangible benefits, eliminating ‘long queues of patients’ in waiting rooms and improving access.

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