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GPs told to give patients face-to-face appointments or be investigated

There are concerns that too many people are being 'shut out' from surgeries and only allowed consultations via telephone or video - Getty Images
There are concerns that too many people are being 'shut out' from surgeries and only allowed consultations via telephone or video - Getty Images
Coronavirus Article Bar with counter
Coronavirus Article Bar with counter

GPs have been ordered to give patients face-to-face appointments amid warnings that they will come under investigation if the public is denied care.

A letter is being sent to every family doctor in the country following growing concern that too many people are being "shut out" from surgeries and only allowed consultations via telephone or video.

Health chiefs have warned GPs that failure to offer appointments in person is a "breach of contract" and may heap pressure on Accident and Emergency departments.

It comes as the "rule of six", making it illegal for larger groups to meet in most circumstances, became law across the country despite a mounting backlash from MPs and scientists.

Boris Johnson, the Prime Minister (seen announcing the measure in the video below), is under pressure from his own MPs to follow Wales and Scotland by exempting children under 12 from the rule.

Sir Graham Brady, the chairman of the 1922 Committee of Tory backbenchers, told Times Radio: "It's peak infringement of people's liberties and their right to a normal family life, and you could mitigate quite considerably by excluding younger children, the people we know who are least likely to be affected by the virus, less likely to spread the virus. I think it makes perfect sense to do that."

Professor Carl Heneghan, of Oxford University, said the policy was "catastrophic" and had no scientific evidence to support it, warning the measure could be the one that "tips the British public over the edge".

On Sunday the UK reported 3,300 new coronavirus cases and five deaths, with the daily cases figure above 3,000 for the third day running.

Polling by the British Medical Association showed that nine in 10 doctors expect a second wave of coronavirus (see graphic below), but Prof Heneghan said it was "wide of the mark" to assume that the upturn in cases would necessarily translate into excess deaths, accusing Mr Johnson of panicking and introducing "rash and arbitrary" policies.

It follows mounting unrest within the Cabinet and growing anger from Tory MPs about measures that one of the Government's own scientific advisers described as "irrational".

Professor Peter Openshaw, who sits on the the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), highlighted complaints about the fact that large groups could meet for sports while both grandparents could not visit a family of five. But he suggested the alternative could mean "hard lockdown".

The developments come amid concern that NHS measures introduced in response to Covid-19 are having devastating consequences, with patients denied basic healthcare.

On Monday, NHS chiefs will write to every GP in England, instructing them to ensure patients can access face-to-face appointments, not just consultations by phone or video. Patients' groups have warned that vulnerable people, especially the elderly, are being "shut out" from surgeries under measures introduced to stop the spead of the virus.

Sir Simon Stevens, the head of the NHS, said on Sunday night that patients had "rightly" highlighted the need for face-to-face visits, as figures showed that almost half the 102 million GP consultations between March and July were delivered by phone or video.

Doctors hit back, with the Royal College of GPs saying it was an "insult" to suggest GPs had not been doing their job properly.

The letter from Dr Nikki Kanani, medical director of primary care for NHS England, addressed to all family doctors, says: "Many of you will be aware of reports by some patients that they are experiencing difficulty in accessing their GP for needed face-to-face appointments.

"We are writing to reiterate the importance of providing face-to-face appointments for those who need them."

Such consultations should always be offered when clinically appropriate, the letter adds.

Additional guidance goes further, saying patients should be told that online and phone appointments "can be convenient and flexible... but if you would prefer to see a GP or healthcare professional in person then this will be arranged for you".

It comes amid concern about rising numbers of deaths among people who went untreated for killer diseases, such as heart conditions, during lockdown. In the two months to July 10, deaths linked to high blood pressure rose by one third among the under-65s, while those linked to diabetes increased by a quarter.

Charities have raised concerns that the fall in visits to GPs during lockdown, and reduced numbers of referrals for cancer checks, could mean a sharp rise in deaths. At the height of the pandemic, referrals from GPs to check symptoms fell by 75 per cent, with UK modelling suggesting this year could see an extra 35,000 cancer deaths.

Data from the Office for National Statistics shows that people dying at home from causes other than Covid-19 have fuelled excess deaths across the UK this summer (see graphic below).

Excess Deaths - UK-wide
Excess Deaths - UK-wide

Figures for the two months ending August 21 show more than 6,700 extra deaths in homes across the UK, of which just 203 involved coronavirus.

The letter warns GPs that they could be investigated, and face enforcement actions for breach of contract, if they refuse to offer patients face-to-face care. Ultimately, practices that fail to comply could be closed down, although health officials said they hoped GPs would act on Monday's recommendations.

"Local commissioners will investigate any complaint from a patient that they are being refused face-to-face consultations when there is an identified need, or that they are being directed to Emergency Departments inappropriately," the recommendations continue.

The NHS chief executive, Sir Simon Stevens, said: "Patients are rightly saying that as well as the convenient option of a phone or online GP appointment, practices should continue to offer face-to-face appointments for all those who need them. The NHS is confirming with GP practices that that requirement remains in place."

Patients will continue to need to call ahead or visit the practice website for an appointment before attending, the guidance says.

On Sunday, Professor Martin Marshall, the chairman of the Royal College of GPs, said family doctors had been delivering a "predominantly remote service" in order to comply with official guidance to stop the spread of the virus.

He said: "Any implication that they have not been doing their job properly is an insult to GPs and their teams who have worked throughout the pandemic, continued delivering the vast majority of patient care in the NHS, and face an incredibly difficult winter ahead.

"The college does not want to see general practice become a totally, or even mostly, remote service post-pandemic. However, we are still in the middle of a pandemic."

Rachel Power, the chief executive of the Patients' Association, said that for many patients, including those without access to technology, remote consultations had not been adequate. She added: "We hope to receive fewer reports in future of patients feeling shut out from their GP."

Caroline Abrahams, the charity director at Age UK said: "We have heard from older people who've struggled to navigate online systems or use unfamiliar technology, from those with sensory or cognitive loss who have found it much more difficult to communicate, and from people who were simply too uncomfortable talking about an aspect of their health remotely.

"We also need to remember that most over-75s are not online, so it's crucial we don't put barriers in the way of them accessing the medical help they are entitled to, just as much as everyone else."