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Britain’s top GP says returning to face-to-face appointments is ‘undeliverable’

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Top doctors today fought back against calls for face-to-face GP appointments to become the default again, claiming that it was ‘undeliverable’. 

The Royal College of General Practitioners, which represents more than 50,000 GPs, said practices were battling staffing issues and increased demand due to delayed diagnoses during the pandemic.

Martin Marshall, chair of the RCGP, also warned there was still too much Covid in the community for practices to return to having packed waiting rooms. 

Boris Johnson last night piled pressure on GPs to offer more in-person consultations, with his spokesman claiming every patient had the right if they wanted one. 

But Professor Marshall told MPs on the Health and Social Care Committee today: ‘There’s no point in having a right if it’s undeliverable at the moment because of the workload pressures.’

He defended the widespread move to virtual GP appointments, claiming it was a ‘positive’ and more convenient for the majority of patients.

Figures show just 57 per cent of appointments are face-to-face now, compared to 80 per cent before the pandemic.

Charities and politicians have been clamouring for the Prime Minister to act amid fears that cancers and serious health conditions are missed in remote consultations.

A damning study published by University College London last night warned of 10,000 extra cancer deaths due to delayed diagnoses and lack of face-to-face care.  

Martin Marshall, chair of the RCGP, warned there was still too much Covid in the community for practices to return to packed waiting rooms

Up to March 2020, around 80 per cent of all appointments across England were in-person, but this dropped to 46.8 per cent last April and has not risen above 57 per cent since

Up to March 2020, around 80 per cent of all appointments across England were in-person, but this dropped to 46.8 per cent last April and has not risen above 57 per cent since

In-person appointments began to increase last summer, before dropping again during the second wave. Despite being on the rise, the figures are still much lower than pre-pandemic levels

In-person appointments began to increase last summer, before dropping again during the second wave. Despite being on the rise, the figures are still much lower than pre-pandemic levels

Professor Marshall said: ‘What we’ve learned from the pandemic is we can do more in general practice remotely than we thought we could, and that’s a positive bit of learning.

‘There’s a lot of stuff that can be done without having to examine someone or be in the same room.

‘Having said that, face-to face-contact is a really important part of dealing with, particularly, more complex problems.’

Full-time GPs are a thing of the past, top doctor warns 

GPs who work full-time is ‘something we won’t see again’, Professor Marshall warned.

Speaking to MPs today at a Health and Social Care Committee on clearing the NHS backlog caused by the pandemic, he said three-day weeks for GPs are here to stay.

Long hours, intense pressure and younger doctors seeking a varied career means doctors working five days will not return.

And while it would save money for current GPs to work longer hours than train more new doctors, forcing them to do so would be unsafe, he warned.

Part-time GPs work 11 to 12 hours three-days a week ‘under intense pressure’, which Professor Marshall noted is ‘pretty much full-time’.

He said:  ‘I don’t think it would be our job as a professional body to force people into working more sessions where they don’t feel safe working those extra sessions, and that’s the position we’re in at the moment. 

‘The pressure that general practice is under not only impacts on our ability to provide personalised care, which is what we want to do as GPs, but it is increasingly impacting on our ability to provide safe care. 

‘So if I force one of my colleagues – in whatever way I can, which I have no levers to do – but if I was to say to someone you’ve really got to be working four days a week and as a consequence they start making diagnostic errors or prescribing errors, that’s not good for anybody. 

‘So while general practice is under pressure, there are very few people who feel that they are able to work full-time. 

‘And secondly we have to accept the reality that the younger generation, of clinicians of all sorts, want career portfolios, they want mixed careers, they don’t want to work full time. So the model of a full time GP I think is probably something we won’t see again.’

Responding to Downing Street’s comments last night, he added: ‘People are saying that the patient should have a right.

‘There’s no point in having a right if it’s undeliverable and it is essentially undeliverable at the moment, because of the workload pressures.’ 

He said GP workload had gone up over the pandemic ‘and indeed over the last decade’.

And he added: ‘The second thing is, really importantly, the pandemic isn’t over.

‘We’d like to think it is – it isn’t over, it might be over for pubs and nightclubs, it’s not over for health services.

‘It’s really important that if you run a health service, whether it be in general practice or in hospitals, that you protect vulnerable patients.

‘Around one in 70 and 80 patients in this country have got Covid, so the idea of having somebody who is fit and healthy but shedding the virus sitting next to someone who’s vulnerable in a waiting room is just not something that’s acceptable.’

Professor Marshall was asked by committee chair and former Health Secretary Jeremy Hunt about people not being able to see the same GP for repeat appointments.

He told MPs that staffing shortages and flexible working had made it difficult to guarantee that each patient has one assigned family doctor.  

Professor Marshall said: ‘I think the essence of general practice is the long-term relationships that the patients and their GPs are able to develop, that gives you an understanding of people’s health beliefs and allows you to make diagnoses more effectively.

‘So this concept of continuity of care has long been something that had been an important part of general practice.’

However, he said ‘not all patients need continuity all the time’, although there was evidence that people seeing the same GP had dropped over time.

On the reasons why, he added: ‘Patients are less likely to stay in one place for a long period of time, GPs are more likely to work part-time, more likely to be geographically mobile as well, so there are a lot of societal factors as well as health service factors that have contributed.’

He said there was a need to build the general practice workforce ‘to get back to general practice being able to deliver more personal care and GP and patients getting to know each other more effectively.

‘We’re a long, long way away from that, at the moment.’

The British Medical Association warned last week that England is short of around 50,000 doctors.

The BMA said that the number had fallen behind comparable European Union countries, with 2.8 doctors per 1,000 people compared to an EU average of 3.7.

Graph shows: The number of people waiting to see a cancer doctor in the UK jumped from just over 5,000 at the start of the pandemic to nearly 30,000 in June this year

Graph shows: The number of people waiting to see a cancer doctor in the UK jumped from just over 5,000 at the start of the pandemic to nearly 30,000 in June this year

Patients are shelling out a fortune to see a private GPs, healthcare providers say 

Patients are increasingly paying to see a doctor privately, according to healthcare providers.

For a fee of about £100, a face-to-face consultation can be arranged almost immediately, sometimes on the same day.

Patients usually do not need to be insured or even to have a ‘referral’ if they are paying for it out of their own pocket.

Spire, Britain’s second-biggest private healthcare provider, is reporting an 81 per cent increase in ‘self-pay’ patients this year compared with 2019.

It charges £90 for a 30-minute appointment described as ‘quick and easy access to private GP services – when you need it’.

A spokesman told the Mail: ‘People are in pain and they are choosing not to wait for incredibly stretched GP services and the NHS to treat them.’

Dr Neil Haughton, a private GP in Notting Hill and the president of the Independent Doctors Federation, said: ‘We have never been busier.

‘All my private GP colleagues are saying we can’t keep up with demand.

‘We are literally inundated. Some we have to turn away because we don’t have enough slots.

‘The fact is, patients want to come and see me, they don’t want a video consultation.

‘And as a doctor, you can miss the nuances if you don’t see your patients directly. You don’t pick up on the invisible things.

‘It’s also inequitable. My 90-year-old mum, for example, hasn’t got a smartphone or a computer, and actually you need to see people like that in person.’

He added: ‘You can get a mammogram or an ultrasound for a couple of hundred pounds, and people often don’t realise that.’

 

Its research at the start of the summer showed that meeting this average would require scaling up the medical workforce by an additional 31 per cent – or a further 49,162 full-time equivalent (FTE) doctors. 

The staff shortages come after a bruising two years battling the coronavirus pandemic. 

It comes after researchers at UCL said an extra 10,000 people are likely to die of cancer because of a pandemic delays. 

University College London researchers said a drop in emergency referrals from GPs last year across the UK resulted in around 40,000 late diagnoses of the disease.

These delays and longer waits for NHS treatment — fuelled by the pandemic — mean thousands will die ‘significantly earlier’ from the disease than would have been the case pre-pandemic.

The study of more than 2,000 adults found nearly two thirds of people worried about bothering family doctors with ‘minor health problems’ because of Covid. 

And during the first lockdown last year, the NHS moved GP appointments to online and telephone to limit face-to-face consultations. 

No10’s ‘stay at home, protect the NHS, save lives’ messaging put people off coming forward, meaning their symptoms were never investigated.  

A senior coroner in Manchester earlier this month concluded a lack of face-to-face care contributed to at least five deaths in the area during the pandemic.  

Doctors say telephone and video appointments allow them to get through more patients.

But critics believe the pendulum has swung too far and that doctors are more likely to miss the signs of a more serious illness if they don’t see someone in the flesh.

Pressed on the issue yesterday, the Prime Minister’s spokesman said: ‘The NHS has been clear to every GP practice that they must provide face-to-face appointments, and we fully support that.

‘GPs throughout the pandemic have worked hard to see patients and appointment numbers have returned to pre-pandemic levels.

‘It’s right that the public expect to be able to see their GP in person, if needed.’

Although the comments from Downing Street are a positive step, there has been no commitment to take action.

There have been calls to change the way GP practices are funded to incentivise doctors to see patients face to face.

The pressure group Silver Voices is campaigning for a statutory duty to be placed on them to hold in-person surgeries if patients want them.

Caroline Abrahams of the charity Age UK said older people were struggling with telephone triage.

She added: ‘We urge NHS England to challenge and support GP practices that have moved too far, too fast, in their use of technology.’

The BMA said: ‘The move to an initial telephone consultation to assess a patient’s needs was, and is, in line with NHS England’s and the Government’s guidance.

‘Many patients have really appreciated the benefit of alternative types of consultations, which can then be followed by a face-to-face appointment if needs be.’

Patients claim they had to phone GP surgery up to 400 TIMES before being allowed to speak to a doctor 

Patients trying to contact GP surgeries say they are phoning hundreds of times – including one who made 390 attempts before getting through.

People say they are spending hours on the phone to reach doctors – and when eventually connected told they can’t have a face-to-face.

One patient said she needed to change some of her husband’s cancer medication – but she says it took 390 attempts to get through.

Another patient, Mark Cahillane, dialled 269 times on his mobile to reach Ashington House Surgery in Swindon., Wilts.

Mark, 63, said: ‘My wife rang on the landline and it took 45 minutes before she could get through.

‘And then the receptionist was saying that they can’t make a face-to-face appointment until we speak to a doctor. You’re just going around in circles.’

The couple called the surgery the following day and waited another 55 minutes before getting through.

Mark added: ‘Then there’s a call queue which was another 15 minutes.

‘And again, they said they can’t do a face-to-face appointment, ‘you have to wait for a doctor to call you’.

‘Unless you’re familiar with local government policies, you’re a good communicator, you’re articulate or you can use all the jargon, you’re going to get the run around, which is what we got.

‘You’re trying to get things sorted out because the NHS is trying to catch up on the backlog of patients. My wife has a very bad ankle and it’s serious and she needs to get it sorted out.

‘I was trying to be polite and calm. It was stressful as anything.’

After waiting for hours, a doctor ended up calling Mark’s wife.

He said: ‘A doctor rang her, and she was absolutely brilliant.

‘You give respect, you’d like to have a bit of respect and this doctor was absolutely beautiful. And now my wife is getting referred.

‘It’s just the process, the process causes you a lot of distress.’

Another patient, who wished to remain anonymous, said she had phoned the practice 390 times to get through to Abbey Meads Medical Practice, in Swindon, Wilts.

She said: ‘It was for my husband.

‘He’s had cancer and needed to change some of his medication. It was on a Monday, and I know Mondays are always busy – so I just rang the surgery and I just redialled for 390 times – but before I’ve had about over 425 – and then you get put in a queue and you still have to wait.

‘It takes a good hour and 15 minutes to get through, and then they’ll say ‘sorry there’s no appointment, you’ve got to come back tomorrow’ and you start all over again.

‘But how can an old person do that? Someone in their 80s can’t keep trying to get an appointment.’

The woman said she is unable to change her GP practice.

‘I tried to go to Homeground Surgery, and what they said is that if you’re with a surgery, they won’t let you change,’ she said.

‘So, I have to move out of Swindon and then move back to Swindon to change my surgery and have another address.’ 

Assistant practice manager at Ashington House Surgery Dean Mills said the pandemic had seen new working methods introduced.

He said: ‘The introduction of an initial telephone assessment ensures that patients can be cared for by the most appropriate member of our team, either in person or online.

‘Patients can play their part in easing the pressure by calling outside of the busiest times, such as first thing in the morning, and making use of alternative healthcare services, such as NHS 111 and local pharmacies.’

GWH NHS Hospital Trust took on Abbey Meads earlier this year.

A spokesperson said: ‘Our practices are currently experiencing significant pressure and the high level of demand has meant that some callers are waiting much longer than we would like to speak to somebody.

‘We introduced a new electronic consultation system to help provide a better experience for those wishing to access primary care and are working to improve our telephony system as quickly as possible and anticipate a significant improvement from October.

‘We are sorry the caller concerned had to wait such a long time.

‘The booking team, which supports Moredon, Abbey Meads, Penhill and Crossroads surgeries, are working hard every day to answer as many calls as possible.’

 

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