The concept of a digital consultation sounds reassuringly modern so why are we reverting to a technology that’s been around for 150 years?

23 April 2021

According to the most recent data from NHS Digital, more than half of general practice appointments were carried out face to face. This isn’t surprising. Since the low of one in 10 last spring, the proportion of face to face appointments has slowly but steadily increased, in spite of the Secretary of State’s call for 'digital by default'.

What is surprising is that of the 41% of appointments carried out remotely, only 1% were conducted by video or online, the rest by telephone.

The concept of a digital consultation sounds reassuringly modern so why are we reverting to a technology that’s been around for 150 years?

After great enthusiasm for video consultations in the early days of the pandemic it seems that clinicians have decided that once the decision is made to go remote, seeing the patient doesn’t add much value. Or perhaps patients are more comfortable with the telephone or find it more convenient. I suspect it’s also because the tech is still too clunky.

Research tells us that relationship building is usually stronger by video than phone and we know effective relationships lead to both better experience and better outcomes.

Video consultations are a work in progress; I don’t think we should write off them off quite yet.

Latest updates from your College

GP pressures

Perhaps for the first time since the pandemic began, COVID-19 has not dominated the headlines over the last couple of weeks. But it continues to dominate our working lives - and is set to for the foreseeable future.

Even with the bumpy supply issues, hundreds of thousands of vaccines are being administered every day - every one, protecting patients - and still, around three quarters in primary care.

On top of this, general practice continues to deliver the vital care and services patients need from us. We’re at the heart of our communities’ recovery from the pandemic. And, as data from our Research and Surveillance Centre shows, both patient contacts and clinical admin workload are increasing. Some members tell me it’s the busiest general practice has ever been.

A study in Plos One, shared on Twitter by GP Kamlesh Khunti, this week found high levels of depression, anxiety and burnout amongst healthcare professionals. This isn’t surprising given the year we’ve had - and it is certainly reflective of the conversations I have with members.

It’s important that decision makers recognise this, and so must the public at large. It’s far too easy to forget, in the eagerness to return to normal, that healthcare professionals right across the NHS have had one of the toughest years of their careers, and it isn’t over. This pressure can cause friction with patients and with colleagues but now more than ever we need to stick together and support each other.

We’ll continue to advocate for general practice with politicians and decision-makers, and whenever the opportunity arises in the media, especially to defend the profession against unwarranted criticism. Please also remember our wellbeing resources, part of our COVID-19 resource hub.

Updated blood clot guidance

As we learn more, the guidance around the very rare risk of blood clots following the AstraZeneca vaccine is changing rapidly. We’ve updated our Primary Care Management of Suspected Thromboembolism with Thrombocytopenia after COVID-19 vaccination guidance (70 KB PDF) to take into account symptoms to be aware of, other than headache.

Chronic primary pain

Following the publication of NICE guidelines on chronic primary pain a couple of weeks ago, we’ve worked with the Faculty of Pain Medicine, British Pain Society and Chronic Pain Policy Coalition to develop this statement of clarification on what the guidelines mean for patients already taking medication.

The guidance recommends that patients with chronic primary pain, for which there is no known cause, are not started on drug treatment. However, for patients who are already taking medication, they should not automatically stop taking this, particularly if they are finding it beneficial, and the guidelines outline what processes should be followed. We have summarised this.

Our clinical lead for chronic pain, Martin Johnson, led an online webinar on chronic pain management yesterday evening. If you weren’t able to attend, you can still register for access to the session for six months.

Webinar on end of life care

The College is running a series of end of life care multi-professional learning webinars, in partnership with Marie Curie.

Join us for the first one, on Monday 26 April at 19:00 over Zoom, to discuss topics including, Advance Care Planning, DNACPR & What Matters Most Conversations. The event is being chaired by RCGP and Marie Curie National Clinical End of Life Care Champion, Dr Catherine Millington Sanders, with guest expert speakers Professor Mark Taubert, Consultant in Palliative Medicine & Honorary Professor Cardiff University, School of Medicine, and Catherine Baldock, Clinical Lead for ReSPECT, Resuscitation Council UK.

If you’d like to attend, you can register now.

Health inequalities

The Deep End initiative which involves many College members is doing some fantastic work to deliver care and services to patients in some of the UK’s most deprived areas, and tackle health inequalities. One of the founders of the Deep End Group, Professor Graham Watt in Glasgow, has asked me to share the following. I’m very happy to do so.

The US anthropologist Margaret Mead remarked, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has".

The latest group of GPs to prove this rule are the Deep End Projects, spreading from Scotland to Ireland, Canberra, Yorkshire, Greater Manchester, Plymouth, NW London, Nottinghamshire and North-East and North Cumbria.

The projects not only give identity and voice to general practitioners serving very deprived communities but have also pioneered examples of what makes a difference including extended consultations for selected patients, community link practitioners, practice-embedded financial advisors and Pioneer/Trailblazer Schemes for young GPs. Fifty years after its first publication they show that the inverse care law is not a given to be endured but a challenge that can be overcome. Bravo!

Mercer SW et al. The inverse care law and the potential of primary care in deprived areas. Lancet 27 February 2021, DOI.

National Training Survey

This week, the GMC launched its 2021 national training survey. The survey is open to trainees and trainers, and takes around 15 minutes to complete, via the GMC’s online portal.

If you’ve got the time, it’s a good opportunity to have your say on important issues, including the quality of training, workload and burnout, and workplace and wellbeing. As well as reflecting on the impact of the pandemic on training. More information about the survey is available on the GMC website.

Final reminder - RCGP Council elections

Nominations for RCGP Honorary Secretary and Vice Chair for Professional Development Standards will close at 12 noon on Tuesday 27 April.

Information about the roles, including eligibility criteria is available on the RCGP Council Elections microsite.

Post written by

Professor Martin Marshall, Chair of RCGP Council

Professor Martin Marshall is Chair of the Royal College of General Practitioners and a GP in Newham, East London. He is also Professor of Healthcare Improvement at UCL in the Department of Primary Care and Population Health. Previously he was Programme Director for Population Health and Primary Care at UCLPartners (2014-2019), Director of Research & Development at the Health Foundation (2007-2012), Deputy Chief Medical Officer for England and Director General in the Department of Health (2006-2007), Professor of General Practice at the University of Manchester (2000-2006) and a Harkness Fellow in Healthcare Policy. 

He is a Fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012. He has advised governments in Singapore, Egypt, Canada and New Zealand, has over 230 publications in the field of quality improvement and health service redesign and his primary academic interest is in maximising the impact of research on practice. In 2005 he was awarded a CBE in the Queen’s Birthday Honours for Services to Health Care. 

A co-founder and driving force of the Rethinking Medicine movement, Martin has a passionate commitment to the values of the NHS, patient care and ensuring the GP voice is central in a time of great change. When he’s not working, he likes being outside, preferably on a mountain or a coastal path with his wife Sue and their puppy. 

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