Calls for more face to face GP appointments

Like health centres around the country, surgeries in the borough offered appointments by telephone and online when the crisis began last year.

In Wigan, 58 per cent of appointments were carried out face-to-face in March, based on those for which the appointment type was recorded.

That was down from 68 per cent a year earlier - at the beginning of the pandemic - although NHS Digital said changes in how practices operate during the pandemic may have affected how appointments are recorded.

Now, NHS England has said all GP practices must offer face-to-face appointments and an in-person reception desk, bringing an end to the mandatory “total triage” system.

In a letter, GPs were told the use of telephone and online consultations could 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 nationally are being delivered face to face.

Before the pandemic, some 70 per cent of appointments were face-to-face and 30 per cent were phone, video or online, but this switched to around 30 per cent face-to-face and 70 per cent 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.”

Dr Kanani and Mr Waller added that to ensure receptions can open safely, patients might be asked to queue outside.

The letter to GPs came 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.

Prof 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.”

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