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October 2020

Row over face-to-face consultations rumbles on



Just as the row over an NHS England letter telling GPs to ensure patients could be seen face-to-face when necessary was beginning to die down, a paper from an NHSE board meeting warns that general practice has to get ‘the balance right between phone/online and face-to-face appointments, which are running at around one third to one half of the total.’

The document states that work is underway to ‘recover and restore primary care services to appropriate levels of activity’.

It was published not long after NHSE primary care medical director Dr Nikki Kanani apologised for a letter last month, which warned GPs that failure to offer face-to-face appointments could be a breach of contract.

Responding, Dr Graham Jackson, of the NHS Confederation, said: ‘The vast majority of practices have continued to offer face-to-face consultations where clinically appropriate throughout the pandemic. We should not lose sight of the significant benefits provided by telephone and video consultations and we need to maintain a good balance between face-to-face appointments and remote consultations. Patients’ best interests must be served, and this includes protecting them from unnecessary exposure to infection.’

Editor in chief Beverley Bostock-Cox, an education facilitator and advanced nurse practitioner, commented: ‘Many GPNs will have seen the letter which was sent out from NHSE/I, advising practices that a return to face-to-face appointments "for those who need them", should be implemented. GPNs might have felt that this was not entirely necessary when most nurses had continued to offer face-to-face appointments throughout the pandemic.

‘There is no doubt that some patients have felt short-changed by the move to remote appointments, but we should not lose sight of those who have really valued the improved access to virtual consultations that resulted from the pandemic. It's all about getting the balance right for healthcare professionals and for those who use our services and in my view, we are usually pretty good at knowing when people need to be seen face-to-face and ensuring that they are. The pandemic has led to innovation and diversity in how we deliver care, and I believe that general practice is leading the way in remaining person-centred, including offering a range of ways to connect.’

While data from the RCGP’s Research and Surveillance Centre showed a decrease in demand for routine consultations at the height of lockdown, the number of consultations is now in line with pre-pandemic levels. RCGP chair Professor Martin Marshall said: ‘The fall in consultations was likely due to a number of factors, including patients having concerns about accessing GP services due to fear of contracting the virus or overburdening NHS services – and a desire to follow official messaging to stay at home to help stop the spread of COVID-19.

‘While there was a temporary drop in demand for GP appointments at the peak of the pandemic, GP consultation rates are now back to near-normal levels and the proportion of face-to-face consultations is significantly increasing,’ he added.

And a poll by GPonline found four out ten GP respondents said workload at their practice was currently above normal levels, and more than one in three said current workload was ‘very high’.

Professor Marshall praised ‘GPs and our teams’ for the significant role they had played in tackling COVID-19 and delivering care to patients throughout the pandemic. ‘General practice has been open throughout the pandemic with GPs and our teams continue to deliver the vast majority of NHS patient care to patients with both COVID and non-COVID conditions.’

Practice Nurse 2020;50(8):6