Fylde coast GP consultations to continue remotely as health leaders say 'it must not become default'
As lockdown restrictions are set to ease from Monday, medical leaders have called for patients' access to both remote and face-to-face doctor appointments in a post-Covid world.
The Royal College of GPs (RCGP) is calling on the Government to conduct a comprehensive review of "total triage" platforms and recognise it should not just become the default.
During the pandemic total triage was introduced, meaning that patients are remotely screened and directed to the most appropriate health service for their problem, while GP appointments are delivered remotely, by telephone, video or online, unless clinically appropriate.
New NHS planning guidance said a system of total triage must be embedded into general practice, despite the RCGP’s reservations.
Fylde coast health bosses said phone consultations would remain in place after lockdown is eased, before patients can book an in-person doctor's appointment.
Dr Neil Hartley-Smith, a Blackpool GP and clinical director for NHS Blackpool and NHS Fylde and Wyre Clinical Commissioning Groups (CCGs), said: “While Covid-19 infection rates are coming down and Government restrictions are being eased, GP practices are still very busy and people should avoid just turning up without an appointment.
“Face to face appointments are available for those who need one, however a lot of practices will have a telephone conversation first to assess whether this is clinically necessary.
“This is the same for urgent care services in hospital and at the area’s urgent treatment centres. If you require an urgent appointment please call 111 first and you will be directed to the most appropriate service. If it’s a life-threatening emergency, dial 999.”
Dr Ben Butler-Reid, also a Blackpool GP and clinical director for NHS Blackpool and NHS Fylde and Wyre Clinical Commissioning Groups (CCGs), added: “All GP practices in Blackpool, Fylde and Wyre remain open and are delivering services to their patients.
“However while we are still here for our patients, there have been changes to the services we can offer and the experiences people will have when they book an appointment.
“If you need to make an appointment with your GP, you must first give them a ring. We are working really hard to make sure we keep our patients and our staff safe so it is really important people don’t just turn up as they may be turned away.
“When people do get through to the surgery they will be asked a series of questions and this is so they get the most appropriate appointment with the right clinician. We have found that the majority of appointments can be dealt with over the phone or via a video consultation.
“If it is necessary for someone to come into the practice for a face to face appointment they will be asked to make sure they wear a face covering or a mask and that they follow any practice protocols that have been put in place. This may mean ringing a buzzer before gaining access to the building or staying in their car and calling the practice to let them know they have arrived.”
Charity Age UK, which helps older people, said it hoped face to face appointments for the elderly would be made available if they need one, particularly if they were unsure how to use digital methods to book appointments.
Alison Read, from Age UK Lancashire said: “Although we have seen an increase over the last year in the number of older people who are digitally confident, many others would still be unable to book a GP appointment online.
"We would hope that patients will continue to be able to book appointments by phone and to see a GP face-to-face, when this is required.”
Currently, around half of consultations in GP surgeries are being delivered face to face.
Before the pandemic, some 70 per cent of appointments were face-to-face and 30 per cent were phone, video or online.
But this switched to around 30 per cent face-to-face and 70 per cent remote during the crisis.
The new RCGP study pointed to benefits of online and phone care, including offering patients convenience and flexibility, which may suit people who struggle to take time off work or are housebound.
But it said remote consultations are better suited to more straightforward conditions or queries and where a physical examination is not required.
It added: “In some cases, non-verbal or ‘soft’ cues such as signs of anxiety, self-harm, or smelling alcohol on a patient’s breath, may be more easily missed remotely, or there may be concerns about a patient’s safeguarding, capacity or confidentiality.
“Every patient is likely to sit somewhere along a spectrum between needing remote and face-to-face care, and this will change according to their needs at any particular time and as symptoms or circumstances change.”
The long-term impact of more remote care on the general practice workforce is currently unknown, it warned, with some GPs reporting “that remote consultations can often be exhausting, leading to ‘Zoom fatigue’.”
Some 63 per cent of GPs in a poll said delivering all or mostly remote consultations reduced their job satisfaction and 61 per cent said remote consultations are making the role more transactional.
Some 88 per cent of GPs in the snap poll of 600 GPs also thought face-to-face consultations were important for building and maintaining trusting patient relationships.
The study said the extent to which patients really have a preference for remote care as the need for social distancing is lifted, is also unknown.
Professor Martin Marshall, chairman of the Royal College of GPs, said: “People choose to be GPs to care for patients, as a medical specialty one of our key tools is our ability to build doctor-patient relationships in order to deliver holistic care, and our members tell us face-to-face appointments are important for this.
“It is possible to build relationships via video or phone consultations, but it’s a very different skill to doing so in person, in a consultation room, which GPs have been trained for.
“GPs deserve credit for the remarkable way in which we swiftly transformed the way we deliver care in general practice once NHS England issued its pandemic guidance, both in terms of consulting remotely and implementing ‘total triage’ across the board.
“This was necessary so that we could continue delivering general practice services to patients whilst maintaining infection control in surgeries and keeping people safe.
“Remote consultations have advantages, particularly in terms of access and convenience for patients and making it easier for some hard to reach patient groups to access care.”
Professor Marshall said there is “certainly going to be a place” for remote in the future of general practice and IT investment is needed.
“But we know many patients prefer to see their GP face to face and that many GPs prefer consulting in person, as well,” he said.
“Furthermore, these new ways of working do not reduce GP workload – in fact, there is evidence to suggest triage results in an increase in consultation numbers and remote consultations can take longer.
“As we move out of the pandemic, it needs to be down to individual GP practices to be able to decide how they deliver services, based on their knowledge of their patient population.
“Ultimately, we want to be able to offer patients the choice as to how they want to access GP services based on their health needs.”
An NHS spokeswoman said: “General practice teams have continued to offer face-to-face appointments for patients throughout the pandemic – around 275 million appointments, with half of these taking place in person and more than half on the same or next day.
“Now that background rates of Covid have fallen and lockdown is easing, practices are expected to further ramp up face-to-face options so people get timely and appropriate care depending on need and preference.”