NHS reminder on face-to-face GP appointments 'an insult'

  • Peter Russell, Medscape.com

  • UK Medical News
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Doctors' leaders described a Government call to ensure that patients could have face-to-face appointments with GPs as an insult to their professionalism.

In a letter sent to all GP practices, NHS England said the public should know they had a right to see their GP in surgery in addition to phone and video consultations where it was appropriate.

In March, as the COVID-19 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 that there were 102 million appointments in GP surgeries, half of which were recorded over the phone or through video calls.

The Royal College of General Practitioners (RCGP) said GPs had been offering a predominantly remote service in order to comply with official guidance and help stop the spread of COVID-19.

"Any implication that they have not been doing their job properly is an insult to GPs and their teams who have worked throughout the pandemic, continued delivering the vast majority of patient care in the NHS, and face an incredibly difficult winter ahead," said Prof Martin Marshall, chair of the RCGP.

Breach of Contract

NHS England wrote to GPs on July 31 to advise them of the need to offer face-to-face consultations in what it called the "window of opportunity" before the onset of winter.

It warned that failure to see patients in surgeries, in addition to remote triage and video, online, and telephone consultations, would be considered a breach of contract.

In a news release, Dr Nikki Kanani, medical director of primary care at NHS England, said: "The last few months have seen general practice playing a vital role in the fight against coronavirus, adapting quickly to significantly increase the availability of video and phone consultations and offer safe face-to-face care when needed.

"While many people, particularly those most vulnerable to COVID-19 want the convenience of a consultation over the phone or video, the NHS has been and will continue to offer face-to-face appointments and I would urge anyone who feels they need medical support to come forward so they can get the care, support, and advice they need – the NHS is here for you."

In his response, Prof Marshall said "Any implication that they have not been doing their job properly is an insult to GPs and their teams", who had "continued delivering the vast majority of patient care in the NHS" during the pandemic.

He said that while the College did not want to see a long-term shift to being a remote service, it was right that in the middle of a pandemic, NHS England's guidance "to consider infection control and limit footfall in GP surgeries" should be considered.

Dr Richard Vautrey, GP committee chair at the British Medical Association (BMA), commented: "Any inference that in-person consultations were put on hold is an affront to the committed GPs who have continued to go to work throughout the pandemic."

COVID-19 Second Peak 'Very Likely'

The dispute came as a BMA survey of doctors showed that 85.7% were concerned that a second peak of the coronavirus was 'quite likely' or 'very likely' during the next 6 months.

Last week's poll of 8629 doctors and medical students in England found that 88.8% said a failure of the test and trace system was a risk factor for a second wave.

Confusing messages on public health measures, including face coverings, physical distancing, and rules around social interactions were cited as contributing to the risk by 86% of doctors.

Survey details were released after latest figures on Friday showed that the UK's R number stood at 1.0-1.2, although latest unpublished research led by Imperial College London suggested that the R number could have been as high as 1.7 during the last week of August and the first week of September.

A total of 3330 confirmed cases of COVID-19 were recorded on Sunday – the first time since May that cases were above 3000 on 3 consecutive days.

The uptick in cases led to UK Governments introducing tighter restrictions on social gatherings, including the introduction today of the so-called 'rule of six'.

Dr Chaand Nagpaul, BMA council chair, said: "Today's new measures may attempt to simplify the message and increase enforcement, but it is clear that fundamental other issues urgently need to be tackled. This includes sorting out the test and trace debacle once and for all. It is unacceptable that people and contacts with the infection are not being identified due to failings in the system – which is resulting in the infection spreading blindly.

"With daily cases still alarmingly high, and winter just around the corner, we are at a critical crossroads in the fight against this deadly virus.

"All efforts must be made to avoid a repeat of the horror and tragedy we all experienced earlier this year."

Adapted from Medscape UK.