A total of 43% of 410 GPs who responded to the GPonline poll said changes to the way services have been delivered since the start of the pandemic had made their relationship with patients worse. Some 44% of respondents said there had been no change - and just 13% reported an improvement in the relationship with patients.
The findings shed new light on the impact of the rapid shift in primary care delivery over the past eight months - and on the importance for GPs of finding the right balance between remote and face-to-face care beyond the pandemic.
GP surgeries have been instructed by NHS England to adopt total triage and video, online and telephone consultation wherever appropriate during the COVID-19 pandemic to limit infection risk.
Despite a huge rise in the proportion of GP appointments delivered face-to-face since the early stages of the pandemic, the shift in general practice remains huge. Just under 40% of GP consultations were delivered in person in the four weeks to 18 October this year - compared with 73% over the same period in 2019, according to RCGP surveillance data.
Health and social care secretary Matt Hancock recently said remote consultations had been a 'lifeline for the NHS' during the pandemic - and has previously argued that where appropriate, all GP consultations should be conducted remotely in future.
Leading GPs have predicted that general practice will not return to delivering pre-pandemic levels of appointments face-to-face - with RCGP chair Professor Martin Marshall suggesting half of consultations could be delivered remotely after the pandemic ends.
However, negative media coverage of access to general practice during the pandemic has seen a rise in abuse and complaints faced by GP practices.
GPs responding to the poll warned that changes to the way they deliver consultations are having an adverse effect on the connection between them and patients - highlighting that some people feel ‘fobbed off’ by new ways of working.
One GP said: ‘There has been difficulty building relationships with new or less well-known patients. Also decreased continuity, reduced levels of trust and an increased sense among patients that they are being "fobbed off".
‘There is also concern about how less technologically able patients are being sidelined. More elderly people or patients with learning difficulties are being dealt with via third parties, or maybe not consulting at all.’
Another argued: ‘Face-to-face interaction is a big part in any relationship, this is no different in a patient-doctor relationship. I think especially, but not exclusively, for mental health issues it is difficult for patients not to be seen face-to-face and for elderly patients similarly, or people suffering from loneliness.’
Other doctors, however, argued that increased use of remote consulting had provided tangible benefits, eliminating 'long queues of patients' in waiting rooms and improving access.
Professor Marshall recently stressed that face-to-face consultations would always be an essential part of general practice, helping to provide ‘safe, effective and personalised care’.
Responding to the survey results, the RCGP chair said: ‘Striking the balance between maintaining trusted relationships - often built with patients over time - and following official guidance to minimise the spread of COVID-19 and ensure the safety of patients and frontline health professionals, has been a challenge.
‘We know that remote consultations will suit some patients better than others but generally, we’ve found that patients have understood the changes and the rationale for them. And where they have been unsuitable, face-to-face appointments are being offered – currently to the tune of more than 400,000 a day.'
He added: ‘We know that face-to-face consultations are the preferred way of interacting for many patients and GPs alike. The college does not want to see general practice become a totally, or even mostly, remote service post-pandemic.
‘We would like to see a more balanced way for patients to access general practice, based on their individual needs and preferences. However, COVID-19 remains a threat and we are now seeing a second wave of the virus, so infection control needs to be considered.’
Polling by GPonline earlier this year found that most GPs believe 50% or more of appointments should be carried out remotely in future. But many expressed concern over potential harm to relationships with patients and the danger of missing serious conditions.