We’re ending the year by republishing our ten most popular pieces from 2021. Here's number eight: a Spectator editorial written in September about the need for GPs to resume face-to-face appointments.
Nye Bevan famously said that he was only able to persuade family doctors to support the creation of the NHS because he ‘stuffed their mouths with gold’. But at least he obtained good service from them — including home visits. Until Tony Blair awarded GPs hefty pay rises while allowing them simultaneously to opt out of night-time and weekend work, they were responsible for their patients’ care 24 hours a day, seven days a week — with practices often pooling resources to provide continuous cover.
But the role of GPs has become increasingly unclear: do patients have a right to be seen in person? It was revealed this week that locum GPs are being offered £100 an hour to conduct telephone appointments from their own homes. Average GPs’ pay now exceeds £100,000 a year for the first time, having risen by 11 per cent in the past four years. Yet it seems to have become harder than ever for an NHS patient to see a GP.
The pandemic threw up obvious challenges, but there is a limit to how long GPs can use Covid-19 as an excuse for refusing to see patients face-to-face. Other parts of society have largely returned to normal. Shops and restaurants no longer have to enforce social distancing. Even nightclubs are open. Yet GP surgeries continue to operate as if we are still in the darkest depths of lockdown. Just 57 per cent of GPs consultations in July were held face-to-face — a little higher than the 47 per cent recorded in April last year but still far below the levels prior to the pandemic. In January 2020, four in five consultations were held face-to-face.
The risk is that the pandemic is used by the NHS and by GPs themselves as an excuse to push for a system of remote consultations. Former health secretary Matt Hancock advocated what he called a ‘health-tech ecosystem’ for the NHS back in 2018. Internet-based consultations were supposed to give us faster appointments at times which suited lifestyles better. Yet there has been no great improvement in the speed of getting to see a GP since the shift to tele-medicine began.
In July, 45 per cent of patients succeeded in having a consultation with their GP on the same day that they made their appointment, while 24 per cent waited more than a week. These figures are a modest improvement on January last year, when 42 per cent had a same-day appointment and 30 per cent had to wait more than a week. But the difference hardly marks a sea change in efficiency. It is not as if GPs are having to see more patients than they were before the pandemic. On the contrary, the number of overall appointments fell from 27.2 million in January 2020 to 25.5 million in July this year.
The NHS, like any other organisation, should make use of technology where it promises to improve services. But evidence that the patient experience has improved is thin. So much for your doctor diagnosing your condition via high-definition video: the vast majority of remote consultations — two in five appointments in July — are now held via a plain old telephone. Just 0.4 per cent were held online.
The failure (or reluctance) of many patients to use the internet to contact their doctor should surprise no one, given the people most in need of seeing a doctor tend to be those least likely to use Zoom. According to the Office for National Statistics, barely half of over-75s are recent internet users.
As oncologists — and to be fair many GPs — have warned, early symptoms of cancer can be very subtle. Signs such as a patient’s changed complexion are impossible to spot during a telephone call, and difficult to see even via a good-quality video call. How many conditions are being missed as a result of GPs failing to see patients in person? This will only become clearer with time.
The drop in face-to-face consultations can’t be laid at the door of GPs alone. Disgracefully, the NHS is offering financial incentives to surgeries to hold certain numbers of consultations remotely. But the British Medical Association is certainly wrong to declare that it should be down to GPs to ‘dictate’ the pace at which services return to business as usual after the pandemic. It shouldn’t be down to the providers of a public service to determine what level of service is available — if it were, there would be little incentive to improve anything.
The rise of private GPs, changing £100 to £150 for a consultation, is a sign of innovation. It is also a sign of the despair people have with the NHS. Far better if these GPs could be reimbursed by the NHS and be part of the system serving the public. If some doctors insist on hiding behind a telephone, then why shouldn’t there be competition for NHS patients?
If GPs will not see patients in the flesh, users of the NHS will quite rightly start to ask whether we should move to a different model of primary care. Perhaps one with fewer, larger clinics which are open around the clock, where people can walk in off the street. It worked for the vaccine rollout, so why not primary care too?
It might be too much to expect to be able always to see a doctor instantly. But a national health service that was genuinely the envy of the world should not be making people wait for a week to speak to a GP — and then only over the telephone.