Nearly 90m fewer face-to-face GP appointments in 2020

Nearly 90MILLION fewer face-to-face GP appointments were carried out in 2020 compared to the year before, NHS data shows amid fury over GPs being told to screen patients online first

  • In-person appointments fell from 238million in 2020 to 148million in 2021
  • The NHS has controversially ordered GPs to screen all patients online first 
  • Patients Association slammed moving appointments online as ‘not acceptable’

More than 90million fewer face-to-face GP appointments were carried out last year, MailOnline can reveal amid fury over a controversial NHS order for GPs to screen all patients online first.

NHS Digital statistics show 147.85million in-person consultations happened between April 2020 and this March — down from the 238.26million during the same 12-month spell the year before. 

Critics slammed the NHS’ decision to divert patients away from face-to-face appointments as ‘not acceptable’. 

Plans to discourage face-to-face appointments in favour of patients having virtual consultations first today prompted anger after they were leaked.

Family doctors have been ordered to adopt a ‘total triage’ system, which will mean all patients must discuss their illness with their GP over the phone or online before they are booked in face-to-face.

Matt Hancock and health chiefs are keen to digitalise the NHS, with the Health Secretary last year embracing ‘Zoom medicine’ when he confirmed all consultations should be taken by phone or video call unless doctors decide they have to see a patient in person.  

Rachel Power, chief executive of the Patients Association, told MailOnline: ‘Access to general practice is clearly extremely difficult for patients at the moment. 

‘The solution lies in ensuring patients get the care they need: it is not acceptable for the NHS to divert patients down routes that don’t work well simply to relieve pressure on the system – that’s not a solution. 

‘Remote appointments, which in truth are mostly by phone rather than new online systems, should remain as an option for those who want them.

She added: ‘But face-to-face appointments with GPs must be restored as the default option.’

More than 90million fewer face-to-face GP appointments were carried out last year, MailOnline can reveal

Dr Jeanette Dickson, president of the Royal College of Radiologists, told MailOnline the drop in face-to-face appointments has meant fewer people are being referred for cancer tests and treatments.

In-person visits are important because doctors can work out more about someone’s illness when they see them in real life. 

But facing backlash in the House of Commons today, senior Tory Jacob Rees-Mogg insisted patients who need face-to-face contact are ‘able to get it’.

The triage system was brought in during the pandemic and sees a person checked by phone, video or online, unless a GP decides they need to be seen in person.

Dr Dickson said: ‘Millions fewer people presenting to GPs has undoubtedly meant fewer people being referred for, tested and treated for cancer. 

‘Polling revealed at the height of the pandemic last year, nearly half of patients in the UK with worrying symptoms did not contact their GP.

‘Oncologists have already seen the direct knock-on of the drops in GP cancer referrals, as thousands fewer patients were diagnosed with cancer last year than previously.

Family doctors have been ordered to adopt a ‘total triage’ system, which will mean all patient must discuss their illness with their GP over the phone or online before they are booked in for a face-to-face appointment

‘Remote GP triaging is a new experience for many patients, and GPs are working hard to ensure they can provide the same high quality of care and referral via virtual consultations. 

GPs are told to screen patients online or by telephone and discourage face-to-face appointments in latest NHS guidance 

Patients should be remotely screened before being directed to the most appropriate health service for their problem, new NHS guidance says.

Doctors are being told the system of ‘total triage’ must be embedded into general practice, despite the Royal College of GPs’ reservations.

The method was brought in during the pandemic and sees a person checked by phone, video or online, unless clinically appropriate.

It comes despite the RCGP saying patients must be able to access both remote and face-to-face doctor appointments in a post-Covid world.

In a new report, general practice leaders said while remote consultations should be an option, they must not become the ‘automatic default’ for GP care.

Currently around half of consultations in general practice are being delivered face to face.

Before the pandemic, some 70 per cent of appointments were face-to-face and 30 per cent were phone, video or online; but this switched to around 30 per cent face-to-face and 70 per cent remote during the crisis.

The new RCGP study pointed to benefits of online and phone care, including offering patients convenience and flexibility, which may suit people who struggle to take time off work or housebound patients.

But it said remote consultations are better suited to more straightforward conditions or queries and where a physical examination is not required.

More complex conditions or those of a sensitive nature are better suited to face-to-face appointments, it said.

It added: ‘In some cases, non-verbal or ‘soft’ cues such as signs of anxiety, self-harm, or smelling alcohol on a patient’s breath, may be more easily missed remotely, or there may be concerns about a patient’s safeguarding, capacity or confidentiality.’

The report added: ‘Every patient is likely to sit somewhere along a spectrum between needing remote and face-to-face care, and this will change according to their needs at any particular time and as symptoms or circumstances change.’

The report warned that the long-term impact of greater use of remote care on the general practice workforce is currently unknown, with some GPs reporting ‘that remote consultations can often be exhausting, leading to ‘Zoom fatigue’.’

Some 63 per cent of GPs in a poll said delivering all or mostly remote consultations reduced their job satisfaction and 61 per cent said remote consultations are making the role more transactional.

Some 88 per cent of GPs in the snap poll of 600 GPs also thought face-to-face consultations were important for building and maintaining trusting patient relationships.

The study said the extent to which patients really have a preference for remote care as the need for social distancing is lifted, is also unknown.

The College is calling on the Government to conduct a comprehensive review of total triage platforms and recognise it should not just become the default.

‘Remote consultations are also not appropriate for everyone. 

‘They may disadvantage some patients, for example, those with impaired hearing, who do not speak English as a first language or who experience digital poverty and problems with connectivity. 

‘Again, GPs are working hard on the types of appointments they can offer and they can and should be able to accommodate patients face-to-face whenever necessary.’

Mr Rees-Mogg spoke in the Commons today after a Conservative colleague raised issues her constituents were having getting an in-person consultation.

MP for Kensington, Felicity Buchan said: ‘Many of my constituents are telling me that they are finding it difficult to get face-to-face appointments with GPs.

‘Whilst I appreciate that telephone and video consultations will become a factor going forward as they are today, will [Mr Rees-Mogg] potentially give a statement to the House saying that face-to-face appointments should be available if they are needed and within a reasonable time frame?’

He replied: ‘General practice appointment levels are, I am glad to say, now close to pre-pandemic numbers. 

‘In February 2021, an estimated 23.5million appointments were booked in general practices in England, an average of 1.19million per working day.’

Mr Rees-Mogg told MPs that ‘55.3 per cent of all appointments’ in February were face-to-face.

He added: ‘So people who need face-to-face appointments ought to be able to get them.’ 

Critics have hit out at the total triage system, with the Royal College of GPs (RCGP) calling for the idea of more remote consultations to be overhauled.

RCGP chair Professor Martin Marshall told MailOnline that while GPs switching to more remote appointments in the early days of the pandemic was necessary for safety, he did not want to see the trend continue after the crisis is over.

He said ‘the data shows how hard GPs are working, delivering a record number of patient consultations in March’.

The 28.4million came on top of taking a leading role in the Covid vaccination programme, with 75 per cent of vaccinations being administered in primary care.

Professor Marshall said: ‘Post-pandemic, the RCGP does not want to see general practice become a totally or even mostly remote service. 

‘Face to face consulting is an essential part of general practice, and when is it safe, it needs to be down to GP practices to be able to decide, in partnership with their patients, how they deliver services. 

‘Ideally, we want patients to have the choice as to how they want to access GP services based on their health needs and preferences.

‘GPs and our teams currently facing intense workload and workforce pressures, we urgently need Government and policymakers to address the unsustainable pressures facing general practice, to prevent GPs and our teams from burning out, so GPs can continue to deliver the care and services patients need.’

The RCGP said face-to-face visits are necessary for patients and doctors to build proper relationships and reduce ‘Zoom fatigue’ for GPs.

Mr Hancock started the drive towards virtual appointments last year, insisting to the Royal College of Physicians it would make life ‘quicker and easier’ for patients.

But politicians have warned general practice has been on the brink of collapse for years, with patients forced to wait two weeks for an appointment before Covid hit. 

The problems have been exacerbated by GP practices closing across the country and a soaring population, with patients at surgeries rising by a third from 2018 to 2019.. 

Around 350,000 patients lost their GP after the closure of 100 surgeries during the same period.

Ministers have pledged to solve the recruitment issue. But GPs say not enough has been done to fix the problem.

GP guidance in January 2020 stated ‘primary care services via online consultations’ would be a key part of care moving forward.

After Covid struck, these were increased to around 90 per cent of all GP appointments, up from 75 per cent pre-pandemic. 

Mr Hancock promised to return the NHS back to normal, pledging regular care would return in in April, before U-turning in July to announce all appointments would be digital first.

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