Every patient to have right to see a GP as NHS abandons ‘total triage’

·5 min read
Picture representing doctor with patient
Picture representing doctor with patient

The NHS on Thursday night performed a climbdown over plans to use online and telephone "screening" for GP appointments and announced that every patient would now have the right to see their doctor face-to-face.

The Telegraph revealed on Wednesday that family doctors had been told to introduce a system of "total triage", meaning those seeking to see their GP were being discouraged and told to have an online or phone discussion first.

But NHS England has now ordered that the system be abolished amid a mounting backlash from patients' groups and doctors. New guidance to all GPs will instead say that every practice in England must make "a clear offer of appointments in person" and respect the preferences of patients.

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Dr Nikki Kanani, the NHS medical director for primary care, and Ed Waller, the director of primary care, wrote to all GPs on Thursday night to inform them that the new operating procedures supersede all previous guidance.

"GP practices must all ensure they are offering face-to-face appointments," the letter says. "While the expanded use of video, online and telephone consultations can be maintained where patients find benefit from them, this should be done alongside a clear offer of appointments in person.

"Practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary, for example the presence of Covid symptoms."

It came after the Patients' Association, the Royal College of GPs, the British Medical Association and Jacob Rees-Mogg , the Commons leader, all raised concerns about the NHS proposal for "total triage".

Jacob Rees-Mogg had voiced concern about the 'total triage' proposal -  Stefan Rousseau/ PA
Jacob Rees-Mogg had voiced concern about the 'total triage' proposal - Stefan Rousseau/ PA

The Telegraph has been inundated with letters from readers describing problems accessing GP care – with one likening their local surgery to Fort Knox – after it highlighted the problems.

On Thursday night, Prof Martin Marshall, the chairman of the Royal College of GPs, said: "This is good news and is what patients and GPs want to see. 

"It removes all ambiguity, and we're particularly pleased that our calls for shared decision-making between GP and patient on the most appropriate method of consultation have been heard. We now have a flexible approach decided upon by clinicians and their patients."

The system of "total triage" was first introduced at the start of the pandemic in an attempt to keep patients away from GP surgeries and reduce the spread of infection. The advice became formalised in annual NHS planning guidance which came into force last month. 

NHS England had always said anyone deemed by a doctor to require a face-to-face consultation should still be able to get one after undergoing remote assessment. But the national system has now been scrapped amid increasing concern that patients were being denied care they needed.

One pensioner told how she had made more than 100 calls a day to her local surgery in Kent on behalf of a neighbour in her 90s in an attempt to get an appointment. When she finally got through, she was told the only way to be assessed was via an online consultation.  

Hundreds of readers highlighted their struggles to access care after The Telegraph reported the case of Joy Stokes, 69, who died from cancer after months of being refused an appointment.

Listen to Joy's story, as told by her husband Nick, on this week's Planet Normal podcast with Allison Pearson and Liam Halligan, from 20:49 on the audio player below: 

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The Patients Association had called for face-to-face consultations to be restored as the "default" option, with the Royal College of GPs (RCGP) saying the policies were too risky. 

Its chief executive, Rachel Power, said some patients had been left with terminal illnesses from conditions that might have been treated if they had been allowed a face-to-face appointment. 

The instructions to the NHS also warn GP practices that they must stop deterring patients from visiting amid widespread use of signs discouraging patients from visits. 

One reader told The Telegraph of a situation in which a GP surgery admitted it had plenty of free appointments available when he visited but told him he would still have to book online. 

Until now, NHS guidance said that those attempting to make an appointment by turning up should be discouraged by being shown how to do so on a smartphone or internet kiosk.

The new guidance says: "All practice receptions should be open to patients, adhering to social distancing … this is important for ensuring that patients who do not have easy access to phones or other devices are not disadvantaged in their ability to access care".

It adds that all patients should be given the same treatment, in contrast to previous advice which said those who tried to book an appointment over the phone should not be given one in case it discouraged people from using online systems, and says: "Patients should be treated consistently regardless of mode of access."

In addition, every GP website must now provide advice about how to contact the doctor, including how to get face-to-face or walk-in services.

Figures for February this year show that 55 per cent of all GP appointments were face-to-face, compared with 81 per cent the year before. 

It comes as the latest data showed that almost five million people are now waiting for NHS hospital treatment – the highest number since records began in August 2007.