Remote GP consultations not suitable for everyone

The Royal College of GPs has said that, while convenient and efficient for many, remote consultations ‘won’t be suitable or preferable for everyone’.

The RCGP has released the results of a survey of its members and said that remote consultations can provide both benefits and challenges for patients and GPs. General practice has undergone a ‘technological revolution’ during the coronavirus pandemic and the RCGP says that there are lessons to be learnt from the new ways GPs and their teams have been working – but that post-pandemic it is vital patients are able to access GP services in ways that meet their health needs and preferences.

The survey of 829 GPs across the UK, which looked at access to general practice services, found that between 9 July and 22 July on average, 61 per cent of GP appointments were conducted by telephone, with a further 16 per cent spent doing telephone triage. Additionally, 11 per cent were conducted face to face, six per cent by SMS or email, four per cent online via video and three per cent were home and care home visits.

Although only four per cent of consultations were reported being done by video, the survey found that 88 per cent of respondents said their surgery was equipped to deliver video or e-consultations and that 74 per cent said they had done at least some consultations in this way.

Asked about the efficiency of delivering consultations remotely, 70 per cent of respondents said telephone consultations increase efficiency, while 67 per cent said video or e-consultations do so. Furthermore, 76 per cent of respondents said that GP-led telephone triage increases efficiency, 66 per cent said non-GP triage and 65 per cent said online triage increased efficiency respectively.

Martin Marshall, chair of the Royal College of GPs, said: “The increase in telephone triage and consultations we have seen during the Covid-19 pandemic has been out of necessity – and in line with official guidelines. That isn’t to say there aren’t lessons to be learnt from the new ways we have been working in general practice. The pandemic has shown care can be delivered effectively and safely remotely, where appropriate.

“Telephone consulting can be convenient for many patients and can also improve access to some of our harder to reach patients – those for whom the actual act of visiting a GP surgery can be a barrier to accessing care, which can include patients with mental health conditions. Telephone consulting does pose a challenge for GPs, not least the lack of visual cues that we often use to help us make a diagnosis – we can’t do physical exams over the phone, we can’t give vaccinations or take blood tests. It’s a different skill to face to face consulting, but it can be effective, especially for patients with simple conditions. The biggest challenge is when patients have complex health needs as being in the same room as a patient, often who you have built up a relationship with over time, is incredibly useful and difficult to replicate remotely.

“Remote consultations, whether by telephone or video, won’t be suitable or preferable for everyone, and that certainly isn’t what the College is suggesting. Once more normal service resumes in general practice – and we await official guidance on this – patients who want face to face appointments will be able to have them. We want patients to be able to access GP services in the way that is best for them and best meets their health needs.”

Speaking to a Royal College of Physicians audience, Health Secretary Matt Hancock said that people should have phone or video consultations with their doctors unless there is a clinical reason not to.

Citing a ‘hugely positive’ response to virtual appointments during the coronavirus pandemic, Hancock said that there now needed to be a shift towards more ‘Zoom medicine’, whereby patients should get in contact first via the web or by calling in advance, so that ‘care is easier to manage and the NHS can deliver a much better service’.

Part of the reason for the shift towards ‘Zoom medicine’ was to avoid falling back ‘into bad habits’.