THE NHS has performed a U-turn and is now saying that face-to-face appointments must return after pledging to discourage them as lockdown loosens.
GPs were told under new guidance that family doctors were to continue the ‘total triage’ system that was introduced at the start of the pandemic.
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But in a letter sent out last night, GPs were told the use of telephone and online consultations can remain where patients benefit from them, but physical appointments must also be available from May 17.
All practice reception desks must now be open to patients, in a Covid-safe manner, so those who do not have easy access to phones or the internet are not disadvantaged when accessing care.
Total triage was a system whereby patients were remotely screened and directed to the most appropriate health service for their problems, and was introduced as a Covid-19 precaution.
GP appointments were also conducted by telephone, video or online unless it was clinically necessary for a consultation to take place in person.
Currently around half of consultations in general practice are being delivered face to face.
Before the pandemic, some 70% of appointments were face-to-face and 30% were phone, video or online, but this switched to around 30% face-to-face and 70% remote at the height of the crisis.
In the joint letter from Dr Nikki Kanani, medical director for primary care at NHS England and director of primary care Ed Waller, doctors were told patients’ preferences must be respected.
“Patients and clinicians have a choice of consultation mode,” they said.
They added: “Patients’ input into this choice should be sought and practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary.”
Dr Kanani and Mr Waller cited the presence of Covid-19 symptoms as an example of a reason to refuse a face-to-face appointment.
“Patients should be treated consistently regardless of mode of access,” they said.
“Ideally, a patient attending the practice reception should be triaged on the same basis as they would be via phone or via an online consultation system.”
The letter to GPs comes just two days after a report by the Royal College of General Practitioners (RCGP) heavily criticised plans to embed total triage into general practice post-pandemic.
The report noted that complex conditions or those of a sensitive nature where a GP might need to pick up on non-verbal queues such as signs of anxiety or indicators of substance abuse can be easily missed remotely.
Professor Martin Marshall, chairman of the RCGP, welcomed the news that the option of in-person services should be available to everyone.
He said: “This is good news and is what patients and GPs want to see. It removes ambiguity and we are particularly pleased that our calls for shared decision-making between GP and patient on the most appropriate method of consultation have been heard.
“We now have a flexible approach decided upon by clinicians and their patients.”
The Telegraph has reported that the previous guidelines state that patients who try to get a face-to-face appointment should be deterred in order to prevent “disincentivising the use of the online system”.
A lot of what we do is build a trusting relationship and to do that you need to be in the same room, so you can pick up the ‘soft signs’.
Professor Martin Marshall, chairman of the Royal College of GPs
“Quick wins” were recommended in the guidance, which includes using pre-set messages.
Guidance also said the new service could be carried out “very quickly” and recommended “quick wins” such as the use of pre-set questions.
Patients who require an in-person appointment will still have access to this, but the new guidance says that some cases can be dealt with entirely over the phone or online.
Royal College of GPs expressed concern that the virtual service offered by doctors during the pandemic should be overhauled.
In the 17-page advice which was updated last month told GPs: “Avoid directly booking patients who telephone the practice into an appointment (although there may be some agreed exceptions). This prevents disincentivising use of the online system.”
“Discourage patients from attending the practice to book appointments. If they do attend in person, demonstrate the process using a smartphone or kiosk”
In the new guidance it states the measures are to “protect patients and staff from avoidable risks of infection” – the same message that was issued at the start of the first lockdown.
Professor Martin Marshall, chairman of the Royal College of GPs said the changes pose a “very real risk” of damaging the relationships between patients and their doctors and severe health problems being missed.
“Once we get out of the pandemic, and things return to a more normal way of living and working, we don’t want to see general practice become a totally, or even mostly, remote service,” he told The Telegraph.
He added: “A lot of what we do is build a trusting relationship and to do that you need to be in the same room, so you can pick up the ‘soft signs.’”