The Health Foundation wrote a really good article on the effects of Covid-19 on Primary Care., citing that:
3.1 million fewer primary care appointments were booked between April 2020 and March 2021 compared to the previous 12 months. A fall from 310 million to 279 million.
The way in which appointments take place has also shifted. In March 2021, the number of telephone appointments in General Practice was 11.4 million compared with 6.6 million in March 2020, and 3.5 million in March 2019.
After the initial onslaught of Covid-19 primary care provision within Practices changed dramatically with remote consultations on the rise to protect staff and patients from any infection risks. The government instructed Practices to conduct all consultations remotely unless there was an urgent need to see the patient face to face. The public were also instructed to “stay at home” in order to protect the NHS & ultimately save lives. The NHS’ Long Term Plan committed practices to offer e-consultations from April 2020 and video from April 2021. So, in essence Covid-19 accelerated the adoption of online technology tools.
Telephone consultation triage models were introduced, with most triaged consultations done via telephone and/or video. The UK market was ready for this change and IT companies who offered video and e-consultations technologies have been expanding ever since. AccuRx SMS Chain, which enables GPs to send SMS messages direct from the patient record, was operational in 50% of GP practices in England by February 2020.
Most clinicians have been overwhelmingly positive about the experience of remote consultations. However, some doctors have said that they struggled with technologies citing poor reception problems, some patients being unable to log on or were unable to get their audio devices to work. GP’s also cited video audio delays which caused patients and the GP to speak at the same time.
According to a recent Pulse survey of more than 850 UK GPs they found 55% want GP consultations to continue to be remote by ‘default’ after the pandemic. GPs who support this move say triaging over the phone first, rather than having an open-door policy, is advantageous in terms of workload. Patients who then need to be brought in can be seen more quickly, they say. But they stress face-to-face appointments should always be available. GPs, though, are cognisant that remote consulting has some safety issues.
Around 45% of GPs responding to Pulse’s survey said misdiagnosis during the pandemic had been a ‘big’ (39%) or ‘significant’ (6%) concern. GPs also reported missing serious cases because physical examination came later. One GP, who asked to remain anonymous, said: ‘We have a patient in their thirties with probable sarcoma, which took several months to diagnose.
MDU head of advisory services Dr Caroline Fryar says: ‘It is becoming clear that working practices in the NHS have irrevocably changed as a result of the pandemic. In some instances, this has brought positive changes such as remote consultations improving flexibility and convenience for patients with, as a consequence, fewer missed appointments. It appears that the pandemic has also led to delays in referrals and increased waiting times, and it’s clear that some GPs are also concerned about the risk of a future complaint or claim for treatment undertaken during the pandemic.
In the long-term whatever model is in place it needs to be one that reduces risk, streamlines operational efficiencies and doesn’t create a culture of suing hard working GP’s.