Face-to-face hospital appointments being replaced by a phone chat with consultant
PATIENTS are being assessed over the phone by hospital consultants rather than having a face-to-face appointment.
The cost-saving initiative is being quietly rolled out across the country to cut the number of patients referred to outpatients clinics.
Normally, patients with a long-term health problem who require further investigations or treatment are referred to a specialist hospital consultant.
The consultant can then decide whether they should see the patient themselves and if not, may advise the GP how to treat them.
Many doctors back the new service and claim it will reduce waiting lists and free up appointments for those most in need.
But charities and patient groups are worried that serious medical problems will be missed as a result of consultants not seeing patients face-to-face.
The ‘Consultant Connect’ service is the latest initiative to try to reduce the number of hospital outpatients appointments, which cost the NHS £200 a time.
It is already in place in 44 of the 209 Clinical Commissioning Groups in England – local health boards – alongside 31 hospital trusts, serving a total of 12 million patients.
Last month the Mail revealed how GPs in certain areas of the country were being told to seek approval from a panel of doctors before referring patients to clinics, although a patient’s GP will retain responsibility and make the final decisions.
And on Thursday, we disclosed that half of GPs say they want to close their lists to new patients so they can provide safe care to those already on their books.
The British Medical Association, which organised the survey of GPs, accused ministers of failing to give enough cash to doctors overwhelmed by ever greater demand on their services.
The Consultant Connect service is run by a private company and local health boards, CCGs, pay a set fee to sign up. Its own data claims it can reduce ‘avoidable’ referrals to outpatient clinics by around 67 per cent.
But Margaret Jeal, acting chairman for the charity Action for Sick Children, said: ‘ A lot depends on whether the specialist asks the right question and the GP interprets the symptoms correctly.
‘If this doesn’t happen, you’ll get children with serious conditions slipping through the net.’
Tom Gentry, of the charity Age UK, said: ‘We know geriatricians can take so much from a face-toface meeting that they don’t get from notes. When identifying frailty, they use this phrase, “You know it when you see it.”
‘Just doing things over the phone misses those subtleties.
‘We also know from older people that it’s very important to them that they see a specialist in person to discuss what might be a range of quite complex problems.’
In a trial of the system in Sunderland, 22 per cent of patients avoided an unnecessary referral, while in one West Midlands CCG, the number of outpatient referrals dropped by 6 per cent over a three-month period.
In Bath, where the service has been running since December 2015, more than 1,600 patients have been ‘ saved’ a hospital attendance, at a cost saving of £711,000 to local commissioners. Dr Charles Bodmer, consultant endocrinologist at Colchester General Hospital, in Essex, where the system was introduced in 2015, said many patients did not need to see a specialist.
‘Before, we would get referral letters from GPs about things that we felt we didn’t need to see the patient for,’ he said.
‘ What we end up telling patients in clinics is often what we could have told them months beforehand over the phone.’
But Dr Bodmer added that not all consultants were in favour.
‘Some don’t want to be part of it,’ he said. ‘There’s a cohort who don’t like giving advice without seeing the patient.
‘The advice I give depends on relying on a clinical assessment the GP has made so I have to trust that.’
Dr Kathryn Patrick, a GP in Yeovil, Somerset, said having a direct line to an expert could save lives.
She described one case where a patient turned up at her surgery with a possible minor heart complaint and she was able to send his ECG directly to a cardiologist – who asked him to go to hospital for an assessment.
Jonathan Patrick, chief executive of Consultant Connect, said: ‘We are not saying we’re a panacea in every case; there are times when an appointment with a specialist, or a hospital admission, is the only option.
‘But there is anxiety when a patient doesn’t know what’s wrong with them, and has to wait for a hospital appointment. If you can have your mind put at rest on the spot, for some patients that will be preferable.
‘A consultant can often glean more about the subtleties of a patients’ condition from a phone call than from an emailed referral from a GP.
‘As a patient I don’t want anyone to gamble with my health and patients who need referrals will still get them.’