Drop in face-to-face consultations could undermine GP training, doctors warn

A sharp reduction in face-to-face consultations during the COVID-19 pandemic threatens to undermine GP training by limiting opportunities for trainees to develop crucial skills, GPs have warned.

Face-to-face consultations limited by COVID-19 (Photo: sturti/Getty Images)
Face-to-face consultations limited by COVID-19 (Photo: sturti/Getty Images)

Prior to the pandemic, around three quarters of GP consultations were carried out face-to-face - but this dropped to nearly one in five at the start of lockdown.

By July, face-to-face consultations had risen by more than 70% compared with the early stages of lockdown, according to GPonline analysis of RCGP data, and face-to-face consultations have continued to increase since then.

However, the proportion of consultations delivered face-to-face remains below a third - a level that GP educators have warned is borderline in terms of providing trainees with enough opportunities to develop their skills.

Face-to-face consultations

GP trainers have said that the move towards predominantly remote consulting because of social distancing measures has limited opportunities for trainees to learn how to build relationships with patients and recognise non-verbal cues.

The fragmentation of consultations - with many practices shifting to a 'total triage' model during the pandemic - is also negatively affecting GP training because trainees often miss out on a crucial stage of the practice's contact with the patient, trainers have said.

Senior GPs fear the impact on trainees could be two-fold. Not only do they risk missing out on key elements of their development, but they could also find training in general practice less rewarding and engaging - and this could affect career choices.

GP trainer Dr Martin Brunet told GPonline that he believed at least 30% of GP consultations needed to be face-to-face to provide trainees with the experience they need to become competent. Nationally, RCGP data suggest this is roughly the level the profession is at - although significant variation between practices is likely.

GP training

Dr Brunet said: ‘What worries me is that the percentage of consultations that are done remotely instead of face-to-face stays very high - that then raises a lot of challenges. For example, how do you train someone with the skills they need for consulting when only 10% of interactions are face-to-face?

‘There are advantages of carrying out face-to-face consultations, such as the ability to pick up on non-verbal cues. How do you gain experience of that if you are just on the telephone? You can do that on video, but the number of consultations done on video is tiny.’

GP educator Dr Helen Salisbury has also expressed concern about the pandemic’s effect on training - highlighting in a BMJ article that consultations had become ‘fragmented’.

Dr Salisbury said it would be harder for trainees to build an understanding of ‘how patients present in the community and how the history and symptoms relate to clinical findings’. Although she admitted that the profession could not afford to pause training.

Decling workforce

BMA polling recently found that one in six GPs plan to quit the NHS or retire early once the COVID-19 pandemic dies down, while 29% plan to work fewer hours.

The GP workforce remains in decline and is now at its lowest point since September 2015 - putting pressure on educators to bring through fresh recruits.

Dr Brunet argued that higher levels of face-to-face consultations would be crucial to keeping GP trainees engaged during training. He said: ‘We can’t train trainees to do only 10% face-to-face consultations because, in reality, most practices are not going to operate like that when the pandemic is over.

‘It’s also really important that they have a good experience. We don’t want them coming into practice and then thinking: "Well this isn’t the job I hoped it would be and I’m not enjoying it".

'We clearly need to keep recruitment up,' he added. 'There’s not only people retiring, but the norm is to work fewer sessions than in the past.'

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