Dr Sarah Jarvis GP updates
Agreat deal has changed about general practice in the 31 years since I became a GP. Appointments were written by hand into a ledger and records of consultations written in notes held in buff folders. In 2021 almost everything is computerised.p This makes it far easier to ensure follow ups aren’t missed and results are received more quickly and reliably. But are virtual GP appointments a step too far?
When the pandemic hit, the NHS sent out a Standard Operating Procedure to GPs – a list of instructions of how theyy had to behave. Top of the lis st was “triage” – we weren’t w allowed to see an ny patient in person un ntil we had assessed th hem to check if they might m have COVID-19.
This built on what th he NHS has been trying t to do for years. We W have a recruitment crisis c in general practice, with numbers of permanent GPs dropping by over 1,000 between 2015 and 2018. Yet in the last 30 years, the amount of work GPs do has increased dramatically. That’s largely because of the amount of preventive medicine we do today.
Just a generation ago, virtually all the work we GPs did involved treating patients who felt ill. Today, as much as half of my work is keeping people healthy – monitoring blood pressure, cholesterol, glucose and more. We now have far more effective treatments for preventing disease than ever before – and as a result we have cut death rates from heart disease in the UK by almost two thirds in less than 30 years.
But that means more work for GPs and with more people being tech savvie, the NHS saw an opportunity to do more consulting online. In 2018, research that suggested up to 3 in 5 people could have their medical problem sorted without a face-to-face appointment. Virtual working is a much more efficient use of doctors’ time, and allows them to do more consultations and sort out more problems.
Virtual appointments, via the internet or phone, are convenient for many patients. They are very popular with people who work, or who don’t want to spend half a day in a doctor’s waiting room. And of course, if you worry about catching infections – as many of us still are – they are the only risk-free alternative.
However, many patients
‘‘ if you don’t have internet access call your practice – they all have alternatives available if needed ’’
prefer the personal approach of seeing their doctor face to face. As do many doctors. A crucial part of my role is just being there for my patients – holding their hands when I give them bad news, seeing their faces light up when they talk about their families. You can’t do that by computer.
Then there are concerns that we might miss a serious problem if we can’t examine a patient properly. However, doctors do have strict guidelines about having the option to call patients in to the practice if they think a patient needs to be examined. It’s not necessary as often as you may think: as a medical student, I was taught that in 80% of cases you could work out the problem from the patient’s story. About 10% of diagnosis, we were taught, depended on examination and the last 10%
IF YOU’RE STILL WORRIED AFTER A PHONE CONSULTATION, ASK YOUR GP WHY THEY DON’T NEED TO SEE YOU – THEY’LL BE HAPPY TO EXPLAIN
needed further tests.
As the pandemic eases, we’re unlikely ever to go back to the way we were – there’s just too much work and not enough GPs. Compromises might even make things better for people who have multiple medical problems.
The proportion of face-toface appointments will rise again – in April, general practices in the UK carried out 31.4 million consultations, almost half the population seen in a single month, and over half were face to face.
But online systems brought in to cope with the pandemic will continue to be there for the young, the time-pressed and the tech-savvie. That will mean more time available for face to face appointments for those who need them most. NEXT WEEK: Cut your risk of a dangerous fall