A report in The Times on Tuesday quoted an NHS England spokesperson as saying that its guidance on face-to-face appointments had been ‘widely welcomed by patient groups as well as GPs themselves, including GPs’ own Royal College.’
However RCGP chair Professor Martin Marshall said on Wednesday that the letter’s ‘tone was misjudged, and the rigid expectations it sent out that practices should make changes at such short notice showed a lack of understanding of the pressures facing the profession.’
He added: ‘The RCGP was not invited to comment on the letter before it was issued. It gave GP practices just three days to make significant changes to their ways of working when GPs and their teams are exhausted, working under intense workload and workforce pressures.’
GPs under pressure
Professor Marshall said the guidance had been ‘demoralising at a time when GPs are under more pressure than ever before and are feeling the strain of more than a year on the frontline of the pandemic effort.’
GPs have reacted with fury to NHS England’s demand. GPonline reported earlier this week that the letter has led to calls for NHS England’s primary care medical director to resign. A petition supporting this call had attracted nearly 950 signatures by the afternoon of 19 May.
On Tuesday the BMA demanded an urgent meeting with health and social care secretary Matt Hancock, condemning ‘unrealistic’ demands for face-to-face appointments for all patients and highlighting ‘unparalleled pressure’ on practices.
In the college’s response to the letter last week, Professor Marshall stressed that ‘face-to-face appointments have been facilitated where necessary’ during the pandemic, and said that the ‘timing and tone of the NHS England letter has proved a distraction from what is really important here’.
‘There also needs to be some flexibility for practices to decide how to best meet their patients’ needs at a local level,’ the original statement said.
However it added that it was ‘encouraging that our calls for shared decision making between GP and patient on the most appropriate method of consultation seem to have been heard.’
Address GP concerns
In this latest statement Professor Marshall said the college hoped NHS England would use the final updated version of the standard operating procedure ‘as an opportunity to address the real concerns GPs have been raising and offer guidance on how to move forward in a safe and practical way’.
‘We are still in a pandemic – there are rising cases of the COVID-19 variant first identified in India – so a sensible and cautious approach to returning to more normal general practice is key,’ he added.
‘GP practices know their patient populations best, and need the flexibility to decide how to best meet their patients’ needs at a local level.’
A report from the RCGP last week argued that a ‘digital first’ approach to general practice should not be considered the default after the pandemic and called for a full review of total triage and remote consultations.
The report made clear that although the college believes remote consultations ‘will remain an important way of delivering general practice services in future’, face-to-face consultations will ‘always remain a major element of general practice’.