Remote consultations by telephone, video and other digital formats have been on the rise for some time - but until the pandemic face-to-face consultations still accounted for around 80% of patient contacts.
However, just a quarter of GP appointments in England were delivered face-to-face in the past month, according to RCGP data that show how primary care has revolutionised services in response to the crisis.
Change to this extent is unlikely to be permanent, but many GPs including RCGP chair Professor Martin Marshall have suggested that after the COVID-19 pandemic general practice is unlikely to revert completely to its pre-pandemic state - with remote consultations likely to play a far greater role than in the past.
GP training reform
Health Education England (HEE) deputy medical director Professor Simon Gregory agreed the pandemic could be a 'springboard for change' and said in a blog post last month that the delivery and assessment of GP training had to reflect the 'new norm'.
He wrote that general practice needed to 'train for the future not the past', with much greater flexibility needed in the profession's future approach to learning and assessment, which he argued should be 'as flexible, if not more so, than our working practices'. Professor Gregory said: 'If many consultations are remote, how do we train for those? What does excellence in remote consulting look like? How does remote supervision work?'
But GPs have warned against a dramatic reduction in face-to-face learning as part of the shift - arguing it must remain at the core of speciality training.
Doctors have also highlighted fears that the clinical skills assessment (CSA) part of the MRCGP test could be scrapped due to an increasing emphasis on remote consulting post pandemic. Under temporary rules to allow trainees to complete their training during the pandemic, video or audio recordings of consultations can be submitted as part of the CSA test.
Guildford-based GP educator Dr Martin Brunet told GPonline that he would be alarmed if there was not 'a robust communication assessment' in the CSA. He said: ‘I think teaching and assessing consultation skills is really key and fundamental for being a GP.
‘The minute we think that it’s just about knowledge and following algorithms or triaging patients alone, then we’re dumbing down what it means to be a GP. Good communication is part of any role of being a doctor, but it’s always been really core to general practice.
‘The face-to-face-consulting is where you really learn the art of being a GP as a trainee as well, whether you are sitting in with your trainer or doing a joint surgery and they are observing you.’
Dr Brunet said the CSA could be adapted to reflect changes in how GPs consult now, suggesting the number of telephone consultation stations in the CSA should be increased.
GPs on Twitter expressed concern that face-to-face learning could be reduced and defended the role of the CSA exam. Primary care educator and Yorkshire sessional GP Dr Kisty Baldwin warned that training would be further dumbed down if it was scrapped.
I think many people have been keen to drop the CSA pre COVID. I worry that COVID will be a good ‘excuse’ and it will never return. Back to getting signed off through WBPA. Further ‘dumbing’ down of GP training? @purmj— Kirsty Baldwin (@kirstybaldwin3) April 30, 2020
Some GPs backed reforming GP training to meet modern needs. Nottinghamshire GP Dr Prakash Kachhala said: ‘Even pre-COVID there were clearly some things that needed to adapt. There’s more acute same day care, more remote consultations - all need to be reflected in training and assessment.’
East London GP Dr Osman Bhatti said he would support a review of the curriculum, revealing that his team had already started using webinars and online learning.
Great article. We have changed the future of primary care, hence need to start thinking differently about #GP VTS training. We've started webinars, online learning & @MicrosoftTeams within #NHSMail to #communicate.— Osman Bhatti (@OsmanBhatti) May 6, 2020
Willing to support review of the curriculum!
RCGP chair Professor Martin Marshall told GPonline that trainees had to have 'the right skills, knowledge and capabilities' to help them navigate clinical practice now and in the future.
‘During the COVID-19 pandemic, GPs and their patients have quickly adapted to very different ways of working, in particular providing remote consultations - but face-to-face consultations are a vital part of general practice and we expect the numbers to start rising again as things start getting back to the “new normal”, and this will need to continue to be reflected in our assessment,’ he said.
‘The college consistently monitors both the curriculum and exam to ensure it keeps pace with the changing nature of general practice and introduce changes, if necessary, to keep the exam valid and appropriate, and we will continue to do so,’ he added.