GPs should return to offering face-to-face appointments without prior triage, says NHS
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1251 (Published 14 May 2021) Cite this as: BMJ 2021;373:n1251
The NHS has told general practices to return to offering patients face-to-face appointments without needing prior telephone or online triage, reversing a policy that has been in place since the start of the pandemic.
A row has surfaced in recent days after the Telegraph reported1 that NHS guidance continued to advise practices to use the “total triage” model, introduced in 2020 to reduce the risk of infection spreading at GP surgeries. The model requires patients to undergo a remote assessment before they can be offered a face-to-face consultation if one is deemed necessary.
But doctors and patient groups have voiced concerns that the system may be preventing some patients from accessing the care they need, and the Royal College of General Practitioners said in a report this week that remote consulting should be an option but not the “automatic default” for GP care.2 The Mail on Sunday also launched a campaign last week demanding that all patients should be able to see their GP face to face.3
Patient preferences
In view of these concerns the NHS issued a new standard operating procedure to practices on 13 May that will replace all previous guidance on the issue.4
The letter from NHS England’s medical director for primary care, Nikki Kanani, and its director of primary care, Ed Waller, says, “GP practices must all ensure they are offering face-to-face appointments. While the expanded use of video, online and telephone consultations can be maintained where patients find benefit from them, this should be done alongside a clear offer of appointments in person . . . Practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary, for example the presence of covid symptoms.”
The new guidance advises, “All practice receptions should be open to patients, adhering to social distancing and IPC [infection prevention and control] guidance. This is important for ensuring that patients who do not have easy access to phones or other devices are not disadvantaged in their ability to access care.”
It also emphasises that patients “should be treated consistently” regardless of whether they are accessing care remotely or in person. “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,” it says, adding that every practice website should provide clear advice about how to contact a GP and ask for help and about accessing face-to-face or walk-in services.
GP workload
Martin Marshall, chair of the Royal College of General Practitioners, 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. 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.”
Richard Vautrey, chair of the BMA’s General Practitioners Committee, called for NHS England to clarify how practices would be expected to meet demand if more patients wanted to see a doctor in person, as covid-19 was still circulating and practices were still limited in how many patients they could have in their premises.
He said, “The letter from NHS England is sadly completely tone deaf, and rather than recognising the efforts GPs are making and the stress they are feeling as a result of the massive workload pressures they are currently experiencing, it has let them down and left them believing their efforts have gone unrecognised.
“Crucially, practices require understanding, support, and resourcing from government so that they can meet demand and are able to offer patients a choice in the ways they can get the care they need.”