Should remote consultations be the default after COVID-19?

Health secretary Matt Hancock has suggested that general practice should follow a remote-first approach to consultations after the pandemic, but do GPs agree?

Rempte consultation (Photo: Westend61/Getty Imges)
Rempte consultation (Photo: Westend61/Getty Imges)

Speaking at the Royal College of Physicians last week, health secretary Matt Hancock argued that ‘all consultations should be teleconsultations, unless there's 'a compelling clinical reason not to.’

Mr Hancock celebrated the success of virtual consulting during the pandemic, saying that patients no longer wanted to 'sit around in a waiting room’. He added that a swing towards teleconsulting had benefited GPs - giving them time to ‘concentrate on what really matters’.

However, many GPs have expressed caution over Mr Hancock's gung ho recommendation of a virtual-first approach. Some would no doubt have even shuddered at his mention of ‘Zoom medicine’.

Remote consulting

Remote consulting has become the ‘new normal’ during the COVID-19 pandemic. RCGP data show that more than 70% of GP consultations were being conducted remotely during March and April this year, a complete reversal of the usual pattern.

But there are still concerns about the limits of remote consulting, the potential harm to relationships with patients and the danger of missing serious conditions.

Surrey GP Dr Martin Brunet, said: ‘There is clear value in being able to offer digital and remote access - for simple transactional consultations it can be very efficient for the patient and work very well.

‘For the health secretary to say that all consultations should be carried out this way unless there is a compelling clinical issue, however, not only asks GPs to practice unnecessarily high risk medicine, but also completely devalues the importance of relationship-based medicine in primary care, much of which is built on face-to-face consulting.

‘He is ignoring the needs of patients who rely on face-to-face interaction, such as those with learning difficulties or hearing impairment, or who simply feel that the trust they need to place in their GP requires being able to see them in person,’ he said.

GP recruitment

Dr Brunet added that the profession would need to think about the impact of predominantly remote working on GP recruitment. 'Will the prospect of spending the majority of the working day on the telephone or answering emails attract the next generation of GPs, or will these ideas be a recruitment crisis in the making?’ he said.

Dr Simon Hodes, a GP in Watford, Hertfordshire, said the pandemic had forced GPs into new ways of working. But he said future decisions around the role of remote consulting would have to carefully consider patients’ needs.

'Whilst it might suit many patients, and although many conditions can be safely dealt with over the phone or by video, much of the patient-doctor relationship relies on body language and non verbal communication and this can be lost.

'We must consider what patients prefer for their mode of contact and also their preferred ways to embrace new digital technology; it can exclude some vulnerable sectors or those with poor access to online services,' he said.

He added: 'Ultimately I hope that all changes are driven by patient feedback and wishes, and consultation with the RCGP and BMA and not driven purely by political will.'

Flexible working

However, COVID-19 has shown many GPs that remote consultations can work. For example, many have found that time has been freed up for longer face-to-face consultations in surgery, while clinicians can routinely work from home - technology permitting.

According to a recent GPonline poll, GPs believe at least half of patient consultations should be carried out remotely after the pandemic. The poll was part of GPonline's first General Practice Insights report, which looked at how the GP consultation would change as a result of the pandemic. The report also found that the vast majority of GPs intended to keep some or all of the new technology they had introduced after the pandemic.

London GP Dr Farzana Hussain said remote consulting had given patients ‘unlimited access to the GP’ as she spoke about the benefits of a new model implemented by her practice.

‘In our practice we’re operating a model where it’s online first unless the patient has learning difficulties, is vulnerable or doesn’t have a smartphone or computer - they can phone first. We try to sort roughly 25% online, 40% with a phone back and 25% of patients get a video call. A very small amount need a face-to-face appointment.

‘Those who have multiple long-term care needs and the elderly can have planned care with face-to-face appointments that are longer than 10 minutes,' she said.

Local preferences

Dr Hussain said the model worked well for her practice, which serves a young population. She added it allowed ‘much more flexible’ working compared to the traditional 10-minute face-to-face consultation for all.

‘We think this model works better for patients and it has increased appointments capacity by 20%. It’s not for 100% teleconsultations, but face-to-face is the minority,' she said.

Most GPs agree that a remote-first approach would not stop patients who need face-to-face appointments from getting them. And, clearly, different areas will need to approach this differently, depending on their location and patient population. But it is far from clear whether conducting the vast majority of appointments remotely, as Mr Hancock, seems to want is what is ultimatly what's best for patients, or GPs.

  • GPonline's first General Practice Insights report, which was published last month, takes an in-depth look at GPs views on how the patient consultation could change as a result of the COVID-19 pandemic. You can read it here.

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