It is ‘not appropriate’ to set a numerical target for the proportion of remote appointments in general practice, a Government inquiry has found.
Instead, practices should work to ‘respond to the needs’ of their local populations and work together with patients to establish the most fitting type of consultation based on clinical outcomes.
The recommendation appears to challenge NHS England’s previous guidance urging GPs to increase face-to-face consultations as part of the GP Access Fund, published in October.
The Committee suggested that NHSE publish its existing review into digital tools in primary care ‘at the earliest opportunity’, advising it should be used as a basis for clear guidance on best practice for GPs for face-to-face consultations.
This should cover how to approach conversations with patients about remote care, in addition to reducing bureaucracy associated with referrals and follow-ups, it suggested.
During the inquiry, the Committee found that while difficulties accessing face-to-face appointments in practices had driven increased demand on emergency departments, it was ‘not the only factor’.
The Royal College of Emergency Medicine (RCEM) told the Committee that changes in the delivery of primary care during the pandemic have made accessing healthcare ‘quicker and easier’ for many but did risk excluding others.
Meanwhile, the Committee warned that it was ‘concerned’ how the shortfall of GPs might impact efforts to tackle the backlog, and how it might affect the current model of general practice.
It said: ‘To address staffing shortages in general practice over the long to medium-term, the RCGP calls on the Government to implement the key recommendations outlined in its action plan for general practice.’
This includes ‘ramping up’ efforts to deliver the manifesto commitment of 6,000 more FTE GPs into the workforce by 2024: a pledge which the health secretary recently admitted the Government was not on track to achieve.
Backlog pressures ‘all parts’ of the NHS
Responding to the report, Professor Martin Marshall, RCGP chair, said the NHS backlog is increasing pressure on ‘all parts of the health service, not least general practice’.
Welcoming the recommendation for robust workforce plans to keep general practice sustainable, he noted that improving retention must begin by tackling the ‘undoable workload’.
‘The relentless and escalating workload is taking its toll on the health and wellbeing of GPs and our teams, so we are also pleased to see the Committee’s recommendation that plans to address this will be developed and published as a matter of urgency,’ he said.
Similarly, Dr David Wrigley, BMA deputy council chair, praised the Committee’s dismissal of ‘numerical target-driven approaches’, including those face-to-face targets.
‘All doctors must be trusted to respond to individual patient need and not be driven by arbitrary bureaucracy,’ he said.
‘And our calls for honest communication and a commitment to keeping in touch with patients have also been heard, with the report stating that no patient should feel ‘abandoned’ by the NHS, even if their waiting times are extremely long.
Meanwhile, Helen Buckingham, Nuffield Trust’s director of strategy, said that demands on the NHS have been growing since ‘long before’ the pandemic, adding that ‘growing waiting times have been a sign of a failure to properly grasp and fund long-term plans to address gaps in rotas’.
She said: ‘The government must be realistic about the pace at which the health service can rebound with the staffing it has.’
The NHS recently saw as many as 26,000 staff absent due to Covid-19 sickness or self-isolation over the Christmas period.
And last month, nearly three-quarters of GPs reported they are worried their workload will negatively impact their ability to provide care for patients over the next few months.