Remote consulting should not be default option

REMOTE consulting should be an option but not the ‘automatic default’ for GP care and services once things get back to normal after the pandemic, said the Royal College of GPs in a new report.

The future role of remote consultations & patient ‘triage’ is the first in a series of RCGP reports setting out how general practice should function in a post-COVID environment. The report acknowledges the potential of remote consulting and other digital ways of working in future and sees a significant role for them moving forward - but anticipates a ‘rebalancing’ between remote and in-person care.

The report found that currently around half of consultations in general practice are being delivered face to face – and at the peak of the pandemic 70 per cent of patients accessed their GP by phone, video or online and around 30 per cent did so face to face. This was compared to 70 per cent face to face and 30 per cent remote, pre-pandemic.

Current NHS planning guidance in England for 2021/22 calls for 'total triage' to be embedded into general practice, but the College states "we are not convinced that the ‘total triage’ model or digital-first triage platforms should be the automatic default for all practices once the need for social distancing has lifted”. It fears this could present a “barrier to care”, with for example overly complicated booking systems.

A ‘snap’ poll of RCGP members conducted in September 2020 found that 88 per cent thought face-to-face consultations were important for building and maintaining trusting patient relationships, and 90 per cent felt that such consultations delivered the best health outcomes all or most of the time.

Over 60 per cent said delivering all or mostly remote consultations reduced their job satisfaction and 61 per cent said remote consultations were making the role more transactional.

Professor Martin Marshall, Chair of the Royal College of GPs, said: "Remote consultations have advantages, particularly in terms of access and convenience for patients and making it easier for some hard to reach patient groups to access care.

"But we know many patients prefer to see their GP face to face – and that many GPs prefer consulting in person, as well. Remote working has been challenging for many GPs, particularly when delivering care to patients with complex health needs. GPs have reported constant remote consulting to be exhausting in a different way to seeing patients in person – and that it can make it harder to pick up on ‘softer’ cues, which can be helpful for making diagnoses.

"Furthermore, these new ways of working do not reduce GP workload - in fact, there is evidence to suggest triage results in an increase in consultation numbers and remote consultations can take longer.

"As we move out of the pandemic, it needs to be down to individual GP practices to be able to decide how they deliver services, based on their knowledge of their patient population. Ultimately, we want to be able to offer patients the choice as to how they want to access GP services based on their health needs."

NHS England recently sent a letter asking GPs to offer all patients face-to-face appointments if that is their stated preference – but it drew criticism from many practices for being "tone deaf" and "badly judged".

Professor Marshall further commented: "GPs and their teams adapted rapidly to new ways of working at the start of the pandemic, but don’t want call-centre medicine for their patients once the pandemic crisis has passed. However, we are still in a pandemic – there are rising cases of the COVID-19 variant first identified in India – so a sensible and cautious approach to returning to more normal general practice is key."