GPs delivered huge rise in face-to-face consultations in week before NHS England letter

GPs delivered a huge increase in face-to-face appointments in the week before NHS England triggered a 'media onslaught' with a letter suggesting practices were refusing to see patients in person, GPonline can reveal.

GPs delivering face-to-face appointments (Photo: Daniel Leal-Olivas/AFP/Getty Images)
GPs delivering face-to-face appointments (Photo: Daniel Leal-Olivas/AFP/Getty Images)

GPs and practice staff have faced a wave of abuse and complaints from the public after media coverage of an NHS England letter to GPs on 14 September, which highlighted 'reports by some patients that they are experiencing difficulty in accessing their GP for needed face–to-face appointments'.

The letter warned practices that failure to offer face-to-face appointments when appropriate may constitute a breach of contract. GP leaders condemned the letter as an 'insult' - and NHS England's medical director swiftly apologised.

Analysis by GPonline sheds new light on why the letter touched such a raw nerve in general practice - it came at a time when workload is higher than at any point this year, and after a week in which GP practices delivered far more face-to-face consultations than in any previous week since lockdown began.

RCGP chair Professor Martin Marshall said the figures showed how 'exceptionally busy' GP practices are currently - and demonstrated how 'ill-judged and ill-timed' the NHS England letter was.

Data from the RCGP research and surveillance centre show that far from shirking their duty to see patients in the ongoing COVID-19 pandemic, GP practices have been rapidly expanding access to face-to-face appointments.

In the week beginning 7 September, the week before NHS England's widely-condemned letter, GP practices delivered 195 face-to-face appointments per 10,000 patients - 25% more than in any week since lockdown began on 23 March.

In the four weeks leading up to the NHS England letter, GP practices delivered 67% more face-to-face appointments than in the first four weeks of lockdown - a figure that rises to 76% once the 31 August bank holiday is factored in.

Face-to-face consultations

Although numbers of face-to-face consultations remain around half pre-pandemic levels, NHS England guidance specifically encourages the use of remote consultations, advising that although practices should be open for face-to-face care, 'remote consultations should be used when appropriate'.

RCGP surveillance data also show that in addition to the huge rise in face-to-face consultations, practices are continuing to deliver more telephone consultations than ever before. Alongside the surge in face-to-face contacts in the week beginning 7 September - week 37 of 2020 - practices delivered more telephone consultations than in any previous week this year.

Home visits are also at their highest level since lockdown began - and e-consultations remain high. The data suggest that the total number of consultations delivered per week now by GPs is similar to levels seen before the pandemic began - although it may in fact be higher because multiple telephone consultations can be recorded as a single event.

Once clinical adminstration work is factored in, however, overall consultation workload in week 37 of 2020 was higher than at any previous point this year, the RCGP data show.

RCGP chair Professor Martin Marshall said: 'This data from the college’s research and surveillance centre shows not just that communications around NHS England’s letter to practices were ill-judged, but that the letter itself was ill-timed, with general practice having just had its busiest week this year, and face-to-face appointments 25% higher than any other week during lockdown.

'It demonstrates how exceptionally busy GPs and our teams are at the moment, and things are only set to get busier as we prepare to deliver the expanded flu vaccination programme and manage the after effects of the first wave of COVID-19, alongside usual winter pressures. Now is the time to support general practice, not demoralise the profession.'

The NHS England letter was widely condemned by GPs. The RCGP said any implication that practices had not been doing their job properly was 'an insult to GPs and their teams', while the BMA called the letter 'an affront' to practices that had shifted to a predominantly remote consultation model - in line with guidance from NHS officials.

LMCs called the impression of general practice created by the letter 'utterly false', 'erroneous and offensive' and said it had stirred up a 'media onslaught' against GPs.

NHS England medical director Dr Nikki Kanani has apologised for 'any hurt' caused by the letter - and said 'any conclusions drawn by the media about my colleagues are not mine'.

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