Doctors have been told to discourage patient appointments in person to promote the use of virtual consultations.
New NHS guidance instructs family GPs to embed a system of “total triage”, meaning that anyone seeking to see their doctor must first have a discussion online or by telephone.
It makes clear that anyone deemed by a doctor to require a face-to-face consultation should still receive one, but says that about a third of all patients’ requests can be dealt with using online messaging.
The advice, first issued in April last year, and updated last September, as a short-term measure, has now been formalised into annual NHS operational planning guidance, which came into force last month.
The guidance for the financial year 2021/22 states: “Systems are asked to continue to support practices to increase significantly the use of online consultations, as part of embedding total triage.”
There is growing concern that vulnerable patients are struggling to get help, with some phoning more than 100 times a day to secure an appointment.
The Telegraph was inundated with letters from readers describing how difficult it was to see a GP after reporting 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:
The Royal College of GPs fears the latest measures have gone too far, and has called for remote consultations to be overhauled.
Guidance issued by NHS England and seen by this newspaper says when a patient calls, they should be encouraged to go online. Doctors are instructed to “avoid directly booking patients who telephone the practice into an appointment” to prevent “disincentivising use of the online system”.
Although practices may decide some “agreed exceptions”, patients should be deterred from finding ways around the system, the national advice suggests.
GPs should “discourage” patients from turning up in the hope of securing an appointment, with such cases given a demonstration of online forms using a smartphone, it says.
Proponents of the system say that it helps GPs to identify and focus on the most urgent and serious cases and ensure that those who need them get face-to-face consultations.
The guidance also suggests that online consultations can be carried out “very quickly”, recommending “quick wins” such as using preset messages.
When the NHS first issued guidance recommending use of “total triage”, it said that such measures were necessary to “protect patients and staff from avoidable risks of infection”.
The same phrase is repeated in the updated guidance, despite falling cases of Covid.
Prof Martin Marshall, chairman of the Royal College, said the changes had gone too far, with a “very real risk” of damaging the patient-doctor relationship and missing serious problems.
He said the Royal College was “pushing back” against the idea, fearing it risked diagnoses being missed. “Once we get out of the pandemic and things return to a more normal way of living and working, we don’t want to see general practice become a totally, or even mostly, remote service. A lot of what we do is to build a trusting relationship – and to do that you need to be in the same room so you can pick up the ‘soft signs’,” – such as anxiety.
While remote consultations could work well for straightforward conditions, or those where a physical examination was not needed, more complex and sensitive cases were likely to need face-to-face assessment, he said.
It follows warnings from the Patients’ Association that new methods for arranging appointments too often “closed the door” for patients. Its polling last month found that 36 per cent of patients had struggled to access GP services, up from 24 per cent last year, with many patients unhappy with the quality of care they received during telephone and video consultations.
Its report said: “It is increasingly clear that many patients have found the new methods for arranging appointments do not work for them. GPs are the front door to the NHS, and patients are increasingly perceiving that the door is closed to them.”
Rachel Power, its chief executive, said that the situation was “worrying” and demanded face-to-face consultations be restored as the “default” option.
On Thursday NHS England will announce £160 million in funding to tackle waiting lists, including systems that use artificial intelligence to decide who is treated first. One scheme, in Lancashire and South Cumbria, will be used for patients waiting for non-urgent surgery, with AI systems used to assess who might fare worst from long waits.
Patients in Surrey will have the option to be assessed by AI, with “chatbots” able to refer people to a physiotherapist or mental health therapist. Some elderly patients in Bristol will be issued with “robots” at home, so consultants at hospitals can make visual assessments of vulnerable patients.
Janet Milliken, 75, from Kent, made more than 100 calls to a GP practice to try and make an appointment for a 91-year-old neighbour. When she got through, she was told there were no appointments left but to go online.
She said that while she was able to navigate the system, she feared for those who could not. An NHS spokesman said: “Now rates of Covid have fallen and government rules are changing from May 17, practices must all ensure they offer convenient face-to-face appointments.”