Over the past 13 months we have all been glued to the health news, and the covid-19 pandemic has dominated our lives. Never before have we needed and appreciated the NHS so much. Given that 90% of NHS contacts occur in primary care (general practice and community pharmacy), the changes imposed by covid have been felt most widely by patients trying to access their GP teams. With over 300 million general practice consultations a year (compared with 23 million in A&E), we all rely on our GP practice at some stage. We have all been immensely grateful for, and proud of, the covid-19 vaccine rollout run by the NHS. It is currently reducing severe illness and death from covid-19. Over 75% of vaccinations so far have been provided in primary care, in addition to usual services. There are many lessons to be learned from the successful vaccine campaign that could be used to shape future healthcare policy.
On 10 March 2020, at the start of the pandemic, Matt Hancock instructed everyone that we must take a digital first approach to accessing the NHS. This meant that all consultations where possible (in GP or hospital settings) had to be performed by phone or video to try and maintain services while reducing the chances of infection for staff and patients. This enforced shift towards delivering consultations remotely led to some very critical narratives in the media, (in some cases it even led to abuse towards GPs). However, GP practices continued to deliver large numbers of face-to-face consultations throughout the pandemic, as well as digital consultations, with recent data suggesting that over 50% of consultations in general practice are currently face-to-face.
While the move to digital consultations works well for many patients, there are recognised down sides. Many patients do not have the technology or skills to use online and digital services. This may be more of a problem depending on finances, medical problems, or disabilities. GP teams are concerned about “digital exclusion” which may once again further widen health inequalities. Many patients simply prefer face to face reviews, and many staff find virtual consultations more tiring to perform, with a perceived sense of increased risk. Virtual consulting reduces human interaction and non-verbal communication. It might reduce the chances of picking up other medical problems mentioned by a patient or picked up by a GP—the “while I’m here doctor.”
On 25 March 2021, a document published by NHS England discussed “total triage,” making it clear that NHS systems will be expected to “support practices to increase significantly the use of online consultations, as part of embedding total triage.” NHS England defines “total triage” as a model in which “every patient contacting the practice first provides some information on the reasons for contact and is triaged before making an appointment.”
It is clear that triage—and remote consultations—have become embedded, and will have a role to play in general practice beyond the covid-19 pandemic. However, it is very unclear how, or if, patient groups have been involved in a “total triage policy.” Given that each patient and each GP practice is unique, perhaps it should be up to individual GP practices, in consultation with their patient groups, to decide locally what works for their population?
Given the known workforce crisis in general practice, and the increasing demands being placed upon the NHS, some form of digital triage in future will be essential to manage workload.
We learn from history that war (in this case viral) forces many changes to society, and also technological advancement. Perhaps as we see light at the end of tunnel, the NHS is now at a watershed moment, where we should take positive advances forwards, driven by patient engagement and consultation, to try harness new technology and provide the best care we can within the resources available.
Simon Hodes has worked as a GP partner in the same Watford practice since 2001, and is also a GP trainer, appraiser and LMC rep. The views expressed above are his own. Twitter: @DrSimonHodes
Competing interests: none declared.