The Remote GP Consultation: No Turning Back?

Peter Russell

February 15, 2021

The remote GP consultation is here to stay, but how concerned should practitioners be about a world in which face-to-face appointments in the surgery become the exception rather than the norm?

The transition was dramatically accelerated last year as COVID-19 swept across the UK and general practice was advised to reduce its patient footfall to cut transmission of the SARS-CoV-2 virus.

In March 2020, as the pandemic took hold, NHS England advised all practices "to change face-to-face appointments booked online to triage appointments via telephone or video".

Between March and July, NHS Digital estimated there were 102 million GP appointments, half of which were recorded as being over the phone or through video calls.
 

'Impossible to Turn Back the Clock'

The matter was a pressing theme at the RCGP's 'A Fresh Approach to General Practice' virtual conference where Prof Martin Marshall, RCGP chair, argued that the shift to phone and video consultations risked "the dilution or loss of the relational element of general practice".

However, Prof Marshall acknowledged that it was impossible to turn back the clock and that some patients and some GPs preferred tele-consultations.

In a later session, a small panel debated some of the key issues facing general practice from the advance of remote consultations.

Amjad Khan, director of postgraduate GP education for Scotland, said: "There's no doubt the remote consultations are here to stay.

"Where the new normal, or the new balance will be, I don't know, but they are here to stay because they are convenient for some, and especially those who are working, who haven't got time off, and they can quickly get a consultation, either by telephone or by video."

However, he said it was important that training continued to focus on face-to-face consultations because they would remain an important element of general practice "irrespective of what politicians or others say" and because "there'll be large chunks of our communities who not only want but also need that physical contact with the doctor, the nurse, the healthcare assistant, because that is what keeps them going".

The Path to 'Digital Maturity'

Trish Greenhalgh, professor of primary care health sciences at the University of Oxford, said infrastructure remained one of the main problems facing GPs.

Last year she produced a guide on introducing video consultation for practices during the COVID-19 pandemic.

She said practices need to ask whether they were "strategically ready" and had "the leadership to deliver digital services". Also, infrastructure played an important role as there were "some practices in this country that still don't have a decent broadband connection".

Overall, "most practices seem to be pretty much in the middle of 'digital maturity'".

Last summer, Prof Greenhalgh and her team were awarded a £750,000 grant to address the technological tools that GP surgeries use to interact with patients.

The 'Remote-by-Default' care project will assess the changes needed to scale up and deliver better remote care.

"The thing about medicine is that it is governed not by hard and fast rules [and] standard operating procedures, but by professional maxims or rules of thumb, which apply in some but not all circumstances. But the question is, what are those rules of thumb, and how can we balance stipulating them explicitly, versus leaving scope for the 75% of patients who are exceptions to the textbook case? And that's precisely what we're doing research about."

Prof Greenhalgh said it was important to consider diversity of provision, catering for the patient who wants to speak to a human being when he or she contacts the surgery, as well as "all the whizz-bang stuff".

Dr Roger Neighbour, a former RCGP president, who now lectures on consulting skills and general practice, warned of the dangers of evolving the system to the stage where the starting point was "digital until proven otherwise".

It was important to preserve "access to the full complexity and wisdom of the system", otherwise "we're in danger of losing something very important", he maintained.

"It behoves the old ones amongst us to make sure that the rising generation really do get to know and experience the reward and the fulfilment of doing face-to-face consultations, because once that's lost, it's lost forever," he added.

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