Telephone consultations mean stressed GPS and dissatisfied patients

SIR – In 2008 I analysed more than 2,000 GP telephone consultations – setting out to demonstrate the benefits of this method of care.

They averaged five minutes in length. Over half had to be followed by a face-to-face consultation, averaging 10 minutes. If, as reported, 57 per cent of patients now see their GP in person following a telephone consultation, the result is a 7 per cent increase in workload compared to seeing all patients in person.

Patients generally want to visit the surgery to consult a doctor, and telephone consultations leave neither the doctor nor the patient fully satisfied. This increases GP stress and leads to further appointment requests – yet more work for the GP.

Telephone consultation should only be used when requested by a patient.

GPS’ workload can be reduced through skill mix – having people in non-medical roles working alongside them. However, a major potential source of staff has been overlooked – the huge number of people who volunteered to assist the NHS in the pandemic. Lay people can be used in health screening, to measure height and weight, and test blood pressure. Less than 7 per cent of GPS who volunteered were called on. They could provide support to practices. Simon Fradd MRCGP

London SE1

SIR – It isn’t just GPS who have cut back on face-to-face consultations. The last time I saw my oncologist was 10 days before I completed my radiotherapy for neck cancer. In the six months since, I have had monthly telephone consultations, mostly with a doctor but occasionally with a nurse.

After a couple of chats, the report to my GP stated: “I saw Mr Simpson in clinic today.” How can they justify this? Roger T Simpson

Northampton

SIR – In 1993 I joined a practice of two GPS delivering all primary care to 3,600 patients with the help of two receptionists. An average patient came four times a year. Now, two GPS lead a team of 30 extensively trained staff caring for 4,800 patients. An average patient visits nine times a year.

We no longer refer everyone with blood pressure problems, asthma, diabetes, chronic kidney disease, high cholesterol and so on. We diagnose and manage these in house.

Seeing that the country could not fill all the gaps by training more GPS, the Government introduced clinical pharmacists, primary care mental health practitioners, first-contact physiotherapists, even befrienders, and many more ancillary roles to help GPS. This is called skill mix. These professionals assess, investigate, prescribe, refer and treat within their own specialties better than I can.

Politicians therefore need to stop telling patients to demand face-to-face appointments with a doctor and advise them to engage with receptionists and be signposted to the right member of the extended primary care team.

Dr Ken Leeper Billinghay, Lincolnshire