Targets for remote GP consultations 'disingenuous', says BMA

Targets promoting online GP consultations are 'disingenuous' alongside criticism of access to face-to-face care and could drive up inequality, GPs have warned.

Dr Krishna Kasaraneni (Photo: JH Lancy)
Dr Krishna Kasaraneni (Photo: JH Lancy)

Last week, NHS England announced that PCNs will be able to access 'significant funding' through the Investment and Impact Fund (IIF) by delivering on 26 indicators.

Among targets for PCNs is a requirement for GPs to continue to offer online consultations to patients 'consistently across the country as we exit the pandemic’, with practices expected to provide five online consultations per 1,000 patients per week.

However, the BMA has condemned the move, calling it 'disingenuous' for the government or NHS leaders to set targets for online consultations after demanding more face-to-face appointments.

Remote consultations

A senior clinical advisor to the NHS Confederation has also warned that the targets around online consultations could negatively affect quality of access for some patients rather than improve it.

The warnings come as RCGP chair Professor Martin Marshall last week defended the efforts of GPs during the pandemic, rejecting claims that practices were refusing to offer patients face-to-face appointments.

At the start of the pandemic GPs were instructed to switch to largely remote consultations to reduce the spread of COVID-19. But numbers of face-to-face consultations have risen steadily in recent months, with practices now delivering well over half of all appointments in person.

Despite this, GPs have continued to receive criticism from the public and politicians that they are ‘refusing to open their doors’. In May NHS England angered GPs after it sent a letter reminding them of their duty to offer in-person consultations.

IIF indicators

Responding to the IIF indicators, Dr Kasaraneni said: ‘As we’ve repeatedly stressed, practices need the flexibility to provide appointments in a way that is clinically appropriate and safe for both staff and patients.

'It’s therefore disingenuous for politicians and NHS England to have, on the one hand, publicly admonished GPs for supposedly not offering enough face-to-face appointments, while setting targets to increase online consultations on the other.'

GPonline understands that some GPs are concerned that online consultations targets could be ramped up in the future, forcing practices into seeing patients in a way that they may not necessarily want, or be best for patients.

Dr Kasaraneni added that GPs were unlikely to ‘chase a target for a small financial incentive’ if patients were better served with face-to-face consultations. He said: 'Staff do not want the use of these systems to make it more difficult for the elderly and others without internet access to see their GP.

Access inequality

‘More broadly, with the pressure practices are under at the moment and as we gear up for what looks set to be an incredibly difficult winter, hitting such arbitrary - and optional - targets will be the last thing on GPs’ minds right now.’

Dr Graham Jackson, chair of NHS Clinical Commissioners and senior clinical advisor to the NHS Confederation, highlighted concerns around how the indicator could increase access inequality. He said: ‘There is a significant possibility that increasing online consultations could perversely result in an increase rather than a decrease in both equality of access for those patients most in need as well as an uptick in population health inequalities.

‘PCNs and GPs are also concerned that new access targets will be very challenging at a time when workforce capacity is severely stretched and under extreme pressure.’

In June, a GPonline survey found that e-consultation systems adopted during the pandemic had driven up practice workload, with 84% saying practice workload had increased. Just 3% of respondents said it had decreased their work.

Face-to-face appointments

A Department of Health and Social Care spokesperson said: 'The government has worked with the NHS on tackling the backlog caused by the pandemic investing £270 million to expand GP capacity, on top of £1.5 billion committed for general practice until 2023/24.

'Thanks to the dedication of GPs and their teams, appointment numbers have returned to pre-pandemic levels, with more than 330 million delivered in the last year.

'While telephone and remote consultations can be more flexible and convenient, they’re not right for everyone. The government fully supports the need for surgeries to provide face-to-face appointments alongside telephone and online appointments, which practices are already doing.'

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