Health secretary has 'overplayed his hand' on remote consultation benefits, RCGP chair warns

Health secretary Matt Hancock has ‘overplayed his hand’ by pushing for total use of remote consultations, according to the chair of the RCGP, who insisted that face-to-face consultations will always be needed to offer 'best patient care'.

RCGP chair Professor Martin Marshall (Photo: Pete Hill)
RCGP chair Professor Martin Marshall (Photo: Pete Hill)

During a webinar with the Royal Society of Medicine on Thursday, Professor Martin Marshall also said that the government's 'protect the NHS' message at the start of the pandemic was 'unhelpful' and had led people with genuine health concerns to stay away from their GP.

Professor Marshall's comments come after health and social care secretary Matt Hancock labelled remote consultations a 'lifeline for the NHS' last week - insisting he wanted to continue to drive forward digital transformation.

The RCGP chair said the pandemic had shown that there was ‘far more’ general practice could do remotely in the future, but insisted GPs were 'taking risks' by working in this way.

Remote consultations

He said: ‘As a college, we have embraced technology and supported practices to implement technology, but at the same time pushed back very hard on those who suggest that general practice could just become a remote medical specialty.

‘We've got a secretary of state who is very enthusiastic about technology, and sometimes I think it's fair to say he has overplayed his hand in terms of his enthusiasm for remote consultations – and we as a college have felt duty bound to push back, which is what we have done.’

In July, Mr Hancock argued that all future GP consultations should be conducted remotely ‘if appropriate’, but this was met by fierce backlash from GPs who accused him of failing to understand general practice.

Professor Marshall said: ‘We are potentially taking risks by not seeing people face-to-face. It’s about much more than just being face-to-face in order to examine someone, or in order to take a blood test. A lot of face-to-face consultations in general practice are about the "soft signs" that we use, that we may not pick up on over the telephone, to make good diagnoses and to help patients.’

Professor Marshall added that GPs had been ‘learning on the hoof’ how to carry out remote consultations since NHS England told all practices to move to a total triage model in March - and stressed that it required a ‘different skill set’ to face-to-face work.

‘I think we’ve got a long way to go as a speciality in understanding how to be effective clinicians when we are conducting remote consultations,’ he said.

Protecting NHS services

Professor Marshall also said that the government's 'Stay home, protect the NHS' message during the first wave of the pandemic had played a big role in the huge drop in GP consultations in April and May. This in turn had a direct impact on the fall in urgent cancer referrals the NHS has seen, he argued.

‘There was a period where patients weren't coming to see us for a lot of reasons, I think partly because they were worried about picking up infection, and partly because they took onboard the message to "protect the NHS".

‘I have to say that in retrospect that wasn't a very helpful message. It was an understandable message at the time - we didn't want to be in the position that we saw in Spain and Italy. But that message I think possibly was taken onboard too much by patients, who didn't then come to see us and we weren't able to refer them,' he said.

COVID-19 vaccine

The RCGP chair also said that GPs would be 'up to the challenge' of delivering the COVID-19 vaccine when it is ready, providing practices were properly resourced and extra staff were deployed to support them.

Professor Marshall said: ‘My feeling is, if general practice is properly resourced, if it's supported with staff, then using our infrastructure and using our expertise, using the confidence that our populations have in us, I think we could all deliver a phenomenal COVID programme, but it does have to be properly resourced.’

A DHSC spokesperson, said: 'GP services have remained open to patients throughout the pandemic, and have been working tirelessly to assist all of us when we have health concerns. GP practices are offering the convenience of remote consultations, whilst continuing to offer face-to-face appointments. We urge anyone who needs help or advice to come forward.

'We are committed to supporting GPs during the pandemic response - the COVID-19 support fund for general practice has assisted with additional costs, and GPs in England are eligible to order COVID-19 PPE free of charge.'

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