In-person GP appointments are ‘not safe’ for patients, British Medical Association says

The British Medical Association has sparked fury by claiming walk-in GP appointments are not safe for patients because poor ventilation means they are at risk of Covid infection.

Critics said continuing to consult patients over the phone or on Zoom would mean many more will be diagnosed later than normal, risking the worsening of serious conditions.

Last month the NHS announced all patients have the right to see their family doctor in person.

Officials had been intent on forcing people to speak to their GP on the phone or via online video chats in a ‘total triage’ system prior to the announcement but were forced into a U-turn after patient backlash.

The new guidance means patients should now be able to visit their surgery to secure an appointment.

But the BMA’s GP committee is against the new guidance and its latest bulletin urges doctors to screen patients online and on the phone before seeing them. 

Professor Karol Sikora, a medical expert at the University of Buckingham and ex-director of the WHO’s cancer programme, said the argument was ‘madness’.

‘It makes sense if the NHS is in crisis but the crisis has gone and we are dealing with the remains now,’ he told MailOnline. 

The British Medical Association has urged GPs to screen patients online or on the phone before seeing them because of poor ventilation surgeries (stock image)

‘The follow-up of patients online is perfectly acceptable, but seeing patients with new illnesses for the first time — it seems risky to do it online, and no other country that I know of is doing this.

‘You need to see someone for the first time to check them, there’s no way you can examine them online.

‘If you take my speciality, cancer, you are going to miss a lot more cancers earlier if they do appointments online and they will be diagnosed at a later stage if you switch to online practice.’

Dr Jeanette Dickson, clinical oncologist and president of the Royal College of Radiologists, said: ‘Patients need to be reassured that face-to-face GP assessments are available, easy to access and will happen quickly if they need them. 

‘Generally, patients should always be examined before a referral is made, and face-to-face consultations are best practice to both reassure patients and talk them through the possibility of a serious diagnosis. 

What was the previous guidance for GPs on about total triage? 

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

Doctors were 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 came 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 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 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’.

‘However, assessment information can be gained via video calls and patient photos and urgent referrals can be made without a preceding face-to-face appointment – and this happened even before the pandemic. 

‘An obvious instance where a face-to-face appointment would be beneficial is for the proper assessment of possible breast lumps. However, in some cases – with symptoms such as coughing up blood or severe weight loss – a hands-on clinical assessment is preferable, but a referral will often be made regardless of what is found on examination. 

‘Face-to-face appointments are especially useful in the case of hearing-impaired patients, those with English not as a first language, when providing reassurance about the safety of hospital attendance, and in order to better direct which service the patient should be referred to.’ 

The BMA letter said: ‘With social distancing and infection protection and control measures still necessary, patients should only receive a face-to-face appointment if they need one, not simply because they demand one.

‘Many surgeries have restricted and unventilated reception areas and are not yet safe for patients to walk in without an assessment.’

People with Covid symptoms have been turning up at practices for appointments, putting staff and other patients at risk, the letter said.

It said practices are ‘already working well beyond their safe limits’ and it is ‘not possible for practices to continue to deliver all that is expected of them’. 

The letter said: ‘The simple truth is that within the constraints of limited resources, dwindling workforce numbers and infection control measures it is not possible for practices to continue to deliver all that is expected of them.’ 

But patients rights organisations have said GPs have to move away from the ‘them and us’ characterisation of doctor-patient relationships and listen to the needs of patients.

Rachel Power, chief executive of the Patients Association, said: ‘It is clear that GPs have had to cope with immense pressures over the last year, so it’s no surprise practices feel overwhelmed. 

‘However, even with the efforts of practices and GPs, a significant number of patients have struggled to get the care they need. 

‘Both experiences are real, and we need to get away from a “them and us” type debate in which doctors complain about what patients “demand”.

‘We want to see doctors working with patients to meet their needs, not simply insisting that they know best and disregarding what patients tell them. 

‘Partnership working is the way out of this difficult moment. 

‘So it’s right that GPs should assess how their patients can be safely accommodated within their premises, and also right that they should provide the face-to-face appointments whose absence patients have so keenly felt.’

Officials last month unveiled plans to fully embed a ‘total triage’ system, with patients asked to talk to a doctor on the phone or via video call before being allowed a face-to-face appointment.

But health chiefs U-turned on the move — which was brought in as a safety feature at the start of the Covid pandemic — after critics hit out.

NHS chiefs updated guidance to say all patients have the right to see their GP face-to-face first.

But the moved sparked immediate backlash from BMA GPs, who said it was based on media backlash and not the ‘needs of the profession’.  

Dr Richard Vautrey, the BMA GP committee England chairman, claimed the letter was ‘the final straw for many hard-working GPs’.

Despite the NHS saying its preference was for face-to-face care, GPs were told last week they would be going down the opposite route.

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.  

But other family doctors hit out at the plans, 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. 

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.’

It comes after MailOnline last month revealed there were more than 90million fewer face-to-face appointments carried out last year. 

NHS Digital statistics showed 147.85m in-person consultations happened between April 2020 and this March. This was down from the 238.26m during the same 12-month spell the year before.

Critics slammed the damning numbers, with Rachel Power, chief executive of the Patients Association, Ms Power saying: ‘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.’