Online GP appointments should not become the default – GP leaders

Patients must be able to access medical appointments remotely and in person in a post-Covid world, the Royal College of GPs said.

In a new report, general practice executives have said that while remote consultations should be an option, they should not become the “automatic default” for GP care.

It comes as new NHS planning guidelines have said that a ‘total triage’ system needs to be built into general practice, despite RCGP’s reservations.

During the pandemic, total triage was introduced, which means that patients are screened remotely and referred to the health service most appropriate for their problem, while GP appointments are delivered remotely, by phone, video, or online, unless clinically appropriate.

Currently, about half of general practice consultations are done in person.

A stethoscope in a practice room at the Temple Fortune Health Center GP Practice near Golders Green, London (Anthony Devlin / PA)

Before the pandemic, about 70% of appointments were face to face and 30% by phone, video or online; but this grew to around 30% face to face and 70% remotely during the crisis.

The new RCGP study highlighted the benefits of online and phone care, including providing patients with convenience and flexibility, which may be suitable for those who have difficulty taking time off work or for patients confined to home. .

But he said remote consultations are best suited for simpler conditions or requests and when a physical exam is not needed.

More complex conditions or those of a sensitive nature are better suited to face-to-face dating, he said, adding, “In some cases, non-verbal or ‘soft’ cues such as signs of anxiety , self-harm, or the smell of alcohol on a patient’s breath, may be more easily forgotten at a distance, or there may be concerns about a patient’s protection, ability or privacy. “

The report added: “Every patient is likely to fall somewhere along a spectrum between the need for remote and face-to-face care, and this will change based on their needs at any time and as patients continue to need more care. symptoms or circumstances change. ”

The report warned that the long-term impact of greater use of remote care on general practice staff is currently unknown, with some general practitioners reporting “that remote consultations can often be exhausting, leading to” zoom fatigue ”.”

According to a survey, 63% of GPs said providing all or most remote consultations reduced their job satisfaction and 61% said remote consultations made the role more transactional.

Some 88% of general practitioners in the snapshot survey of 600 general practitioners also believed that in-person consultations were important in building and maintaining trusting relationships with patients.

The study indicates that the extent to which patients really have a preference for remote care while the need for social distancing is lifted, is also unknown.

The College calls on the government to conduct a comprehensive review of total triage rigs and recognize that this should not simply become the default solution.

A GP checking a patient's blood pressure (Anthony Devlin / PA)
A GP checking a patient’s blood pressure (Anthony Devlin / PA)

Professor Martin Marshall, President of the Royal College of GPs, said: “People choose to be general practitioners to care for their patients, as a medical specialty one of our main tools is our ability to build physician relationships. -patient to provide holistic care, and our members tell us that in-person appointments are important for this.

“You can build relationships through video or phone consultations, but it’s a very different skill to do it in person, in a consulting room, for which GPs have been trained.

‘GPs deserve to be commended for the remarkable way in which we quickly transformed the way we deliver GP care once NHS England released its pandemic guidelines, both in terms of consultation remote and implementation of “total triage” at all levels.

“This was necessary so that we could continue to provide general medicine services to patients while maintaining infection control during surgery and ensuring personal safety.

“Remote consultations have advantages, particularly in terms of access and convenience for patients, and facilitate access to care for certain groups of patients who are difficult to reach.

Professor Marshall said that there will “certainly be a place” for the remote control in the future of general practice and that IT investments are needed.

“But we know that many patients prefer to see their GP in person, and that many GPs also prefer to see them in person,” he said.

“Additionally, these new ways of working do not reduce the workload for GPs – in fact, there is some evidence to suggest that triage leads to an increase in the number of visits and that remote consultations may take longer.

“As we emerge from the pandemic, each of the general practitioners needs to be able to decide how they provide services, based on their knowledge of their patient population.

“Ultimately, we want to be able to offer patients the choice of how they want to access GP services based on their health needs.”

A spokeswoman for the NHS said: ‘GP teams have continued to offer in-person appointments to patients throughout the pandemic – around 275 million appointments, half of which in person and more than half the same day or the next day.

“Now that base Covid rates have fallen and the lockdown is fading, practices should further increase face-to-face options so that people receive timely and appropriate care based on their needs and preferences. “

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