During COVID-19, general practice services rapidly adapted to new NHS England and Public Health England legislation to keep patients and employees safe, maintain infection control and allow general practice workers to continue delivering care (should they need to self-isolate).
Part of this change included the introduction of ‘total triage’, where patients were remotely screened before being directed to the most suitable health service for their problem. As well as this, GP consultations were also advised to be delivered remotely - by video, online or telephone call - unless it was clinically necessary for patients to enter the general practice.
Slowly, throughout the last 18 months, many GP practices have resumed ‘normal’ pre-COVID services, while still continuing to provide remote support for patients in the way of online ‘AskMyGP’ services and other telephone and video conferencing means.
Prior to the pandemic, the NHS Long Term Plan set out a commitment for every patient to have the right to be offered digital-first primary care by 2023/24 and this commitment remains in place today. Supporting the delivery of a digital-first approach, this included an agreed £15m per year of additional funding until 2022/23.
For 2021/22, the definition of the core digital offer was also reconfirmed, with surgeries expected to offer video and online consultations, the ability to do online prescriptions and online appointment booking. However, the arrangement that practices which have implemented and which operate a ‘total triage’ or ‘triage first’ model do not have to meet the 25% online booking contract requirement, has been extended from April 2021.
Moving forward, the Royal College of General Practitioners (RCGP) has said that post-COVID GP consultations should be a combination of remote and face to face, depending on patient needs.
In their most recent report published in May 2021, the college has stated that remote consulting should be an option but not the ‘automatic default’ for GP care and services once things get back to normal after the pandemic. Face to face consulting remains an essential element of general practice.
Three leading patient organisations – Healthwatch England, National Voices and the Patients Association – have spoken out and suggested a significant number of patients have struggled to get the care they need during COVID-19. Their reports suggest many patients experienced challenges with remote care and have had to push to be seen in person even when there has been a clear reason, such as a specific clinical need or a lack of digital skill or confidence.
Alongside this, results from a RCGP poll revealed 88% of GP respondents thought face-to-face consultations were important for building and maintaining trusting patient relationships. Meanwhile, 90% felt they could be efficient in delivering the best health outcomes all or most of the time through face-to-face consultations, compared to 75% over the phone, 46% via video and 18% through online consultations.
It’s clear that GP’s are keen to maintain face-to-face appointments in practices, particularly when delivering care to patients with complex health needs, but this doesn’t mean that all services should revert back to pre-COVID times.
It’s important to account for the number of flexible working practices that surgeries will be able to carry out in the future, due to advances in technology made more available since the pandemic.
The need for remote GP services has consequently and considerably increased since March 2020, as we’ve witnessed the rise in ‘AskMyGP’ services alongside telephone and video conferencing appointments.
However, although business is returning to somewhat normal, many of these remote services have proved to be effective, efficient and will continue to remain in practice throughout England well into the future.
Remote GP services provide greater convenience and significantly cut waiting times for both GP and patient. Remote systems also make it far easier for GP’s to reach out to hard-to-reach patient groups, who would not necessarily have visited the practice in person to access care.
Digital appointments can also be accessed in a relatively short space of time - usually within a few hours of putting a request in - so patients aren’t having to wait weeks for an appointment.
Another important consideration is that, by having fewer members of the public visit GP practices, the risk of infection transmission from patient-to-patient and from patient-to-professional is significantly reduced; a factor that many are acutely aware of due to the airborne transmission of COVID-19. This could, therefore, reduce the risk of costly disruption and employee absences and is, therefore, another benefit of reducing face-to-face appointments to absolute necessary contact.
For practices, offering both face-to-face appointments and remote services may prove a challenge, for both financial and logistical reasons.
Although practices should be enabled with the tools and functionality to deliver a digital-first approach as part of CCG infrastructure responsibilities, RCGP’s recent poll states that 94% of GP’s have said that to get the most out of remote consultations, they needed better broadband and better digital technology hardware. 92% said they needed better quality video consulting and 90% said they needed improved usability of remote appointment software.
Improving tech within your practice can be a costly business and can have a huge impact on the overhead costs of your business. Financially, factors that must be taken into account include the purchase of new software, training requirements for employees, while also ensuring the software is user-friendly for patients, and that they have access to these resources.
However, while remote services may carry additional costs, the decrease in face-to-face appointments should mean GPs are able to respond and provide care to a greater number of patients via digital means and function more efficiently.
With digital-first primary care continuing to be a long term goal for the NHS, the experiences and lessons learned from offering remote services during the pandemic will be valuable in planning for the future.
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