Most GP care should be face-to-face post-COVID, says RCGP

General practice faces a 'rebalancing' between face-to-face and remote consultations as COVID-19 restrictions ease - and a digital-first approach should not be considered the default choice, the RCGP has warned.

RCGP chair Professor Martin Marshall (Photo: Pete Hill)

The college has urged the government to carry out a comprehensive review of total triage and remote consultations. It warned triage systems must become more 'patient-centred' - and called for research to show how remote care and triage can be used safely, while avoiding exacerbating health inequalities and driving unsustainable workload in general practice.

Choosing whether a consultation should be carried out face-to-face or remotely should be a 'shared decision between clinician and patient, and this should be made as simple as possible through triage systems', an RCGP report has recommended.

RCGP chair Professor Martin Marshall said the college does not want to see 'general practice become a totally, or even mostly, remote service' once a more normal way of life returns after the pandemic.

Remote GP consultation

The stance could place the college - and general practice - on a collision course with the government. NHS England guidance earlier this year said NHS organisations should 'continue to support practices to increase significantly the use of online consultations, as part of embedding total triage' and suggested embedding total triage into the health service could be an 'enduring legacy of the pandemic'.

Health and social care secretary Matt Hancock, meanwhile, has said he believes all GP consultations should be remote in future 'if appropriate' - and has suggested 45% of consultations taking place remotely 'feels about right'.

However, in a report on the future of remote consultations and triage, the RCGP has made clear that although it believes remote consultations 'will remain an important way of delivering general practice services in future', face-to-face consultations will 'always remain a major element of general practice'.

RCGP chair Professor Martin Marshall said: 'People choose to be GPs to care for patients – as a medical specialty one of our key tools is our ability to build doctor-patient relationships in order to deliver holistic care, and our members tell us face-to-face appointments are important for this. It is possible to build relationships via video or phone consultations, but it’s a very different skill to doing so in person, in a consultation room, which GPs have been trained for.

COVID-19 pandemic

'GPs deserve credit for the remarkable way in which we swiftly transformed the way we deliver care in general practice once NHS England issued its pandemic guidance - both in terms of consulting remotely and implementing "total triage" across the board. This was necessary so that we could continue delivering general practice services to patients while maintaining infection control in surgeries and keeping people safe.

'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. The pandemic has shown us that high quality care can be delivered remotely and many practices now have the appropriate means to do so effectively. There is certainly going to be a place for it in the future of general practice, and for this we need significant investment in the service, particularly in hardware and connectivity, so that GPs can deliver high quality remote care for patients where appropriate.

'But we know many patients prefer to see their GP face-to-face - and that many GPs prefer consulting in person, as well. Remote working has been challenging for many GPs, particularly when delivering care to patients with complex health needs. GPs have reported constant remote consulting to be exhausting in a different way to seeing patients in person - and that it can make it harder to pick up on "softer" cues, which can be helpful for making diagnoses.

'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.'

Despite a shift towards more care delivered remotely during the pandemic, GP practices have remained open throughout - with around half of appointments currently delivered face-to-face.

Professor Marshall said: 'When you consider last month a record number of consultations were made in general practice, that’s a huge number of face-to-face appointments being made, all in line with current safety measures.

'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. Ultimately, we want to be able to offer patients the choice as to how they want to access GP services based on their health needs.'

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