26 October 2021
General Practice is the front door of the NHS and patients who are sick should contact their practice during working hours. The workforce in these services has remained largely the same, however, facing an increasing and ageing population has increased the demand for, and complexity of, appointments. As a result, practices and senior leadership have sought solutions which improve efficiency and access.
There have been many initiatives but, in the main, increasing patient access via telephone consulting has been a prime factor. This ensures all appointment requests can be prioritised and triaged by a doctor, who will either answer the patients query, provide a face to face appointment and/or make an onward referral. The COVID-19 pandemic has accelerated this change but without the investment in training and infrastructure to make the service comprehensively effective.
The latest data from NHS Digital shows the number of appointments in general practice are back to the levels seen before the pandemic, but there has been a reduction in face to face appointments. This is, in part, due to the technology that allows the submission of photographs of rashes, lumps and bumps to be diagnosed without the patient leaving the comfort of home or work. It has also supported an increase in the number of patients that can be seen on the same day, swelling that figure by almost a million appointments per month in England. In addition, the number of people waiting more than 2 weeks for an appointment have reduced.
There are other benefits to telephone consultations. The development of primary care networks in England and new ARRS roles, including first contact physiotherapists, clinical pharmacists, social prescribers and physicians associates alongside other initiatives such as the community pharmacy consultation service, mean patients triaged by the senior clinician can be directed to an appropriate service more quickly. A consequence of this, is the associative environmental benefit in reducing the carbon footprint of primary care services. In 2020, the BMA[i] showed that patient travel to appointments accounted for around a third of all carbon emissions in primary care. In addition staff travel accounted for around a fifth of the carbon emissions. The move to telephone consultations and the reduction in face to face appointments will support the NHS in achieving its net zero ambitions supporting wider government initiatives at COP26.
Ultimately, choice means patients are able to move practice if the service they receive does not meet with their expectations. There is anecdotal evidence that practices which provide a telephone consulting service are seeing their list sizes increasing. The NHS needs to invest in training to ensure that all practices can offer an effective telephone consulting service for all patients. This will support efficiency, improved patient outcomes and the long term sustainability of the planet and general practice.