Doctors suffering ‘wave of abuse’ over lack of face-to-face appointments

·5-min read
Empty doctor's waiting room - J Hayward/Alamy Stock Photo
Empty doctor's waiting room - J Hayward/Alamy Stock Photo

The British Medical Association (BMA) says doctors are being subjected to a "wave of abuse" from patients over lack of access to face-to-face appointments.

The union has called for an urgent meeting with Sajid Javid, the Health Secretary, amid increasingly fierce rows over the rights of patients to access healthcare

On Tuesday, the head of the Royal College of GPs said the current situation – with just over half of appointments taking place in person – was "about right", adding that the public would "get used to it". 

Patients' groups and campaigners have said many vulnerable people have been unable to access care, with coroners linking a string of deaths to remote appointments. 

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The BMA said claims that GPs were refusing face-to-face appointments were "dangerous" and "inaccurate".

Before the Covid pandemic, around 80 per cent of consultations were face-to-face. But in recent months, levels have remained at around 56 per cent, despite NHS guidance in May which gave patients the right to see a GP in person and told doctors to respect their preference. 

In a letter to Mr Javid, the BMA council chairman said GPs were using telephone, video and online consultations to assess patients and still providing face-to-face consultations "when this is needed".

The Health Secretary has said those seeking face-to-face consultations should be given them, with Boris Johnson's spokesman highlighting pledges made by health chiefs in May

But Prof Martin Marshall, chairman of the Royal College of GPs, told MPs on Tuesday there was no point making such promises when GPs were unable to deliver them.

He told the Commons health and social care committee: "I'd say we are probably about where we should be – a reduction in face-to-face from 80 per cent to 56 per cent on average across the country is probably about right. I suspect patients will get used to remote consultations."

Prof Marshall said the rapid introduction of such systems during the first lockdown meant GPs were still learning how best to adopt them. 

"It's hardly surprising that it's taken time for both clinicians and patients to get used to it, but I do suspect that patients will get used to it," he added. "I don't think we're going to go back to 80 per cent of consultations being face to face." 

Asked about the promises given to the public that their preferences should be respected, Prof Marshall said: "There's no point in having a right if it's undeliverable, and it is essentially undeliverable because of the workload pressures." 

Prof Marshall warned that shortages of doctors meant GPs were increasingly unable to deliver safe care. With the average GP now working three-and-a-half days, he said the model of a full-time GP was "probably something we won't see again". Research has found just one in 20 trainees intends to do the job full-time

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He said it was not his job to suggest other GPs should work longer hours, saying many of those working three-day weeks were working up to 12 hours a day. 

And he added: "I don't think it would be our job as a professional body to force people into working more sessions where they don't feel safe working those extra sessions, and that's the position we're in at the moment."

Prof Marshall said patients could not expect their own preferences to be followed, saying decisions had to be "shared decision between the clinician and the patient". Asked about the risks of such systems, such as cases of cancer being missed, he said: "I think it's happening less [than at the start of the pandemic] but there still is a risk of it."

‘We hear too many accounts of patients pleading to see their GP’

Dennis Reed, the chief executive of Silver Voices, a campaign group for the elderly, said: "It seems to me really arrogant to suggest the level of face-to-face appointments is about right when we are hearing so many accounts of patients – especially elderly ones – suffering and unable to get the help that they need from their GP. We need to get back to at least the levels of before the pandemic.

"We are hearing too many accounts of patients pleading and pleading to see their GP, doing battle with receptionists, and only able to get an appointment by phone or online. The practice of 'remote first' appointments is inherently unsafe and bound to miss symptoms."

In May, NHS England chiefs promised to abandon a system of "total triage" introduced during the first lockdown, giving patients the right to see a GP in person. 

But unions reacted angrily, and since then the percentage of appointments which are taking place face-to-face has remained almost unchanged, reaching 57 per cent in July. 

In the letter to Mr Javid, the BMA called for a change in legislation to increase the maximum prison sentence for assault against emergency workers from 12 months to two years. 

It comes after four members of staff at the Florence House Medical Practice in Openshaw, Manchester, suffered injuries on Friday afternoon. Two were taken to hospital with head injuries and a 59-year-old man was arrested and charged with assault.

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