All GP consultations should be remote by default, says Matt Hancock

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Northerner

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All GP consultations should be done remotely by default unless there is a reason a patient needs to be seen in person, Matt Hancock has said in a speech setting out what he sees as the lessons for the NHS and care sector from the coronavirus pandemic.

The health secretary’s proposal prompted concern from the Royal College of GPs (RCGP), which said it would oppose a predominantly online system, saying both doctors and patients benefitted from proper contact.

Addressing the Royal College of Physicians in London, Hancock argued that while some errors were inevitably made, “so many things went right” in the response to Covid-19, and new ways of working forged in the crisis should continue.

One of these was the huge increase in web-based GP consultations, he said, noting that in the four weeks to mid-April this year, 71% of routine appointments were done remotely, against 25% in the same period a year before.

www.theguardian.com

All GP consultations should be remote by default, says Matt Hancock

Royal College of GPs expressed concern saying it would oppose predominantly online system
www.theguardian.com www.theguardian.com

Well, of course many more were done remotely when you compare it to last year - people were told not to go out or were too scared to go to the doctors. Also this year, many people have died after not seeking care :( Our resident former doctor @mikeyB has often pointed out the limitations of remote consultations. Hancock should not make statements about things he knows nothing about, he's nothing but a glorified accountant - the title 'Secretary of State for Health' doesn't automatically confer any insight or knowledge about health whatsoever, although he seems to believe it does :(
 
Long before Covid our surgery had started trying to do as many consultations as possible by phone. I think the idea being that they would triage you over the phone and then if it was deemed necessary for you to see a doctor you would be given an appointment to see them in person. Presumably trying to reduce the number of time wasters or something. None of us have needed to see the GP for ages so I have no idea whether the system works well or not!
 
Anitram said:
but I can't believe anyone would think it can replace face-to-face completely.
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To be fair, I don't think anyone's suggesting that. Using things like phone (and video) consultations a bit more seems potentially helpful, but I think it would be worth waiting for some research before declaring that all consultations should initially be remote.
 
Sally71 said:
Long before Covid our surgery had started trying to do as many consultations as possible by phone. I think the idea being that they would triage you over the phone and then if it was deemed necessary for you to see a doctor you would be given an appointment to see them in person. Presumably trying to reduce the number of time wasters or something. None of us have needed to see the GP for ages so I have no idea whether the system works well or not!
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Mine been doing this for sometime too, but this put me off ringing for longer than I would have other wise done, with a face to face appointment.
 
Ours were already moving to more phone consultations even before covid. We now have email options which is good for those niggling things that you don’t need an urgent response for but can’t leave forever. Everyone is currently triaged either by phone or email at the moment (through a patient portal thingy which is a bit annoying as you get a text message and an email for everything). The number of in person appointments is minimal and it’s noticeable how few people are in and round the practice at the moment when I’ve gone in for blood tests.

I do think it’s harder to get full history/story on the phone or email. I find our patient portal lacks intuition (you get a checklist of questions and end up repeating yourself a lot). If I could just send an email that says ‘this is what’s happened, here’s a photo of my hand’ then it would be much easier.
 
Has this been Tory plan all along, covid has been perfect excuse to roll it out so will stay in place now.

GP system is chaos, has been for years, gradually run down to point of destruction. Many surgeries around our way cant recruit drs for love or money, running at dangerous levels putting extra pressure on those few who remain, got to be worse still in inner cities.

Obviously there's place for remote consultations, people living in rural areas for example, just shouldn't become normal practice, how does dr supposed to feel glands stomach area over video link.
 
Thebearcametoo said:
I do think it’s harder to get full history/story on the phone or email. I find our patient portal lacks intuition (you get a checklist of questions and end up repeating yourself a lot). If I could just send an email that says ‘this is what’s happened, here’s a photo of my hand’ then it would be much easier
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I found this frustrating when I had to go through loads of questions.
When I spoke to my GP he said look for the General Message option on the email system.

Having said that when I did send an email message at 8:20, I had a reply by 8:30. Very efficient.
I do wonder how long my GP will last with this though. It must be a very different job for them now. Spending time on a phone and replying to emails. Agreed it is more efficient, but what a change.

The email system gives you time to consider and make sure you include all the facts, although the box I had to type into was tiny and I had to keep scrolling (I guess it is a system designed for phones). What it doesn’t. Always get across is how you feel about it all.

I suspect that there will be things that fall down a gap with this system. It is not easy to get all info across in the same way, and I am not sure. How I would feel if I did not already know my GP and have been with him for over 20 years.
 
For people like me the web based system is far better than face to face. I tend to avoid going to the doctor and have in the past gone for years without doing so even though I knew I had issues that needed attention. I have learned to carry out minor procedures on myself rather than see a doctor in person and while for me that worked out okay it isn't ideal.

The reasons I avoided seeing doctors have been an inability to cope with making phone appointments because I can't cope with the stress of being on hold for ages nor trying to negotiate complicated phone systems - listen to this and press this for this and listen to this list and then if... etc etc. gets me in such a tizz and by the time a person answers I am almost non verbal. Then waiting in a waiting room causes me huge stress and anxiety even without the anxiety of knowing I have to see the doctor face to face and being around ill people and having to touch surfaces to register I'm there.

I get into the GP room and I'm a bag of nerves and my blood pressure is through the roof and I have massive trouble keeping my thoughts in order - so there is the list I have to write first and then try to find. Then I can't remember what he's said because I am using all my powers on not freaking out or crying.

So I've had three web consultations with my GP and one with my Respiratory department since lockdown -all of which were necessary and none of which I would have bothered with if the old system had been my only choice. All turned out to be things I should have had sorted out and would have caused worse problems in future if I hadn't.

I had one video appointment because he needed to see the problem and two of the other three were sorted via message and the third by phone and it turned out I needed a different CPAP mask which they posted to me and I had it within a couple of days.

So far I've been very impressed by the speed and thoroughness of the way my surgery and hospital have managed with remote appointments. My husband who is deaf prefers them too because he can communicate clearly using the remote technology. I suppose it depends on whether or not the patient can accurately and honestly communicate with the health professional and for me I manage that much better remotely as it is a million times less stressful for me.

In the past my husband has asked the receptionist to use the loop system to help him communicate and then they spent ages rooting about under the desk to pull out an old dusty box with dirty old equipment that he was supposed to put over his head!!! They said they never used it because "All deaf people bring sign language interpreters." !!!

They made him feel like he was being awkward because he 'doesn't look deaf' whatever that means.

So remote works much better for him as he isn't made to feel 'the wrong sort of deaf.'
 
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@nonethewiser has hit the nail on the head.

When I was GP training, I was always taught to watch people come in to my room - demeanour, short of breath with the effort to come from the waiting room, nicotine stained fingers, complexion, and how they sat down.

I remember one patient, a 76 year old Polish veteran, who presented at the surgery (before we started) complaining of back pain, so the receptionist was being a bit officious. I went out to take a look, and he didn’t look well. Got him into my room and asked him to get up on the couch. No great bother, no mechanical difficulty, so he clearly didn’t have a back problem. Planted a hand on his abdomen and felt the pulsation of a large aortic aneurysm, which was about to kill him. It didn’t, because I got an ambulance to blue lighting him to hospital, where they spent about ten minutes assessing him before replacing his aneurysm with a Teflon replacement.

Do that online, if you can.
 
Another consideration is those who may have difficulty getting to the surgery (in normal circumstances). Telephone/online consultation might be better. For at least an initial consultation. Depending on cirumstances of course.
There are also plenty of people who need urgent attention. Need to get the balance.
I'm non "normal" presentation for my heart attack/issues. There wasn't the pain and I missed it. The reporting of symptoms can't always be relied on. Also, I've had repeated infections in my legs. It comes on quite quickly, and I need treatment before I'm able to get a normal appointment at GP practice.
In my case, having a history, I sometimes get quicker attention if I manage to say the "right" things.
 
Really interesting discussion.

I think remote appointments will have their place, but we need to remember how wafer thin the online experience is.

These days you could spend your morning with Google Maps visiting virtually any city on the planet, ‘walking‘ it’s streets and boulevards. Taking in the sights. Seeing the views from the optimum vantage points taken by pro photographers on the best day, with the fewest crowds. But I doubt you would feel like you had actually ‘been there’ in any meaningful sense.

Face to face will always have an important role to play. The internet should be used for what it’s good at (and some GPs may find it very helpful to get through a bunch of *some* routine stuff quickly and efficiently)... but it’s not a replacement for geniune contact.
 
It boils down to our innate humanity. We are social animals, like many higher primates, and need social contact. A video consultation is no better than watching TV to satisfy that urge. I noticed this at my recent video neurology appointment, and so did the consultant. She openly said it was unsatisfactory, because she couldn’t see me.
 
At the height of the covid pandemic when we first went into lockdown, i had a telephone appointment with my oncologist. Normally at the hospital appointment i would have a naso- endoscopy ( thin flexible camera inserted up my nose and down my throat). This obviously was a great tool for the oncologist to monitor and make sure mr badman (cancer) had not returned. Over the phone obviously couldn't examine me. I do think some appointments could be done remotely using various technologies and some need face to face appointments.
 
i am with hepato on this, there are times when telephone or online are okay but there are other times when it is not okay.
 
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mikeydt1 said:
i am with hepato on this, there are times when telephone or online are okay but there are other times when it is not okay.
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I feel the same.
I have had telephone appointments and recently used e consult for the first time for something very minor that needed treatment .
They all have there place.

Personally I would be very happy to go in for my regular diabetes checks then as I am well controlled have the option for a telephone appointment with my DN once the results were in, but no, she does my weight and bp, so I don’t have any choice in the matter.
 
I rang a couple, of weeks ago to see if Asthma and Diabetes checks were being done a my surgery , to be told they are are only Phone and nurse will only see if they feel necessary. As I won't have had any bloods are checks I did not see the point.
My surgery don't appear to have an e consult.
 
just after posting my message a hospital letter plopped through the letter box, of course it was for a telephone consultation but as it relates to surgical i just don't feel it is appropriate for a consultation down a wire when a examination is usually needed.

the problem is we can't see inside ourselves so basically anything could be going on. as it was only xmas when they told me in person that my bowel is stuck together why they feel it is now okay to consultant down a wire is beyond me and who is to say that i end up discharged when something could be going wrong, then it is all the rigmaroles of going back through the doctors.

as you can tell this is not a time for a consultation down a wire and as off i have told them to re-book when they can get to see me in person, the person of course didn't like it, i say to anyone stick to your guns.
 
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