- In response to the coronavirus (COVID-19) pandemic, the NHS issued guidance to protect GP services and patients, bringing big changes to the way general practice operates.
- These changes include assessing all patients via telephone initially, seeing patients face-to-face only when necessary and setting up dedicated ‘hubs’ to manage all suspected COVID-19 patients.
- The latest NHS Digital data show a 30% fall in the overall number of GP appointments in England in March. Face-to-face appointments have fallen and partially offset by a rise in telephone appointments.
- These data may not count other kinds of appointments taking place, such as in hubs, or telephone triage, but they may also reflect a drop in the number of patients contacting their GP.
What guidance has been given to GP practices and patients so far?
On 18 February, the NHS took action to protect both GP practices and hospital emergency departments from COVID-19, by advising people with a relevant travel history and suspected symptoms to call NHS 111 and not to go to their GP practice, pharmacy or hospital.
NHS England contacted GP practices on 5 March to advise them to stop online bookings for face to face appointments (to avoid infected patients coming in without warning) and switch to a telephone-only triage system.
On 19 March, NHS England published further guidance. This included moving to a total triage system (ie speaking to all potential patients before an appointment is made), identifying a small number of practices locally for face to face appointments (those for suspected COVID-19 patients are often known as ‘hot-hubs’), moving as much care as possible to remote-only means, and preparing for an increase in home-visiting. GP practices were also told that their income would continue at the same level as before the outbreak, regardless of changes in activity level. Finally, they were advised that they could defer some types of routine care, such as medication reviews or health checks for the over 75s, where needed.
The current guidance on NHS.uk is for patients to avoid going directly to their GP in person, but to phone or use online services to contact their GP surgery for advice about how to access care. Patients are told they will only be asked to visit the surgery if absolutely necessary and are warned that ‘you may have to wait longer than usual to speak to someone if it’s not urgent’.
What do we know already about what’s happened in general practice?
According to a survey conducted with 1,000 GPs by the Royal College of General Practice, reported on 19 April, the majority of consultations were taking place via phone or video call.
There have been reports in the media that face to face appointments have declined. NHS England, in launching a public campaign to encourage people to use the NHS, also report survey data that suggests that four in 10 people are ‘too concerned about being a burden on the NHS to seek help from their GP’. In their most recent letter to the NHS, published on 29 April, NHS England report that practices have moved from having around 95% of their consultations face-to-face, to over 85% taking place ‘remotely’, via phone or video link.
What do the latest data tell us?
The NHS has been collecting data on activity in General Practice in England since 2018. The data comes directly from GP electronic record systems, and does not reflect all the activity that GPs and practice staff undertake, for example contacting hospital specialists or chasing laboratory results. It only partially captures telephone triage and home visits. The data collection was set up to give the NHS a broad picture of pressures faced in General Practice, for example to help with planning for winter pressures. It does not contain information about individual patients.
The latest NHS Digital data for March 2020 show a reduction from 6,026,140 appointments (of all kinds), recorded in the first seven days of the month, to 4,225,502 in the last seven days (a 30% fall). Comparing the same time periods, face-to-face fell from 4,851,606 appointments to 2,153, 988, while telephone and video/online combined rose from 900,346 to 1,887,263. NHS Digital states that this ‘does not necessarily imply that GPs are offering and booking fewer appointments overall’. This is because not all appointments may have been captured, for example those in the COVID-19 ‘hot hubs’, telephone triage calls, and online appointments because staff have been too busy to update their systems.
The results do suggest that that face to face appointments have reduced, and only partially replaced by telephone or other methods. Patients may be using NHS 111 instead or avoiding contact with their GP, because of worries over infection or overloading NHS services.
Next month will bring data for April, which might shed more light on what’s happened within general practice during COVID-19. Over the next few months, other more detailed data sources will be released which will allow us to explore how this shift away from face-to-face appointments has affected different groups of patients.