All GP consultations should be far off by using default, says Matt Hancock

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All GP appointments should be done remotely by default unless a patient needs to be seen in person, Matt Hancock has said, prompting doctors to warn of the risk of abandoning face-to-face consultations.

In a speech setting out lessons for the NHS and care sector from the coronavirus pandemic, the health secretary claimed that while some errors were made, “so many things went right” in the response to Covid-19, and new ways of working should continue.

About consultations
Consultation may refer to:

Public consultation, a process by which the public’s input on matters affecting them is sought
Consultation (Texas), the 1835 Texas meeting of colonists on a proposed rebellion against the Republic of Mexico
Consultation (doctor), a formal meeting with a medical doctor for discussion or the seeking of advice
Consultation in object-oriented programming, see Object aggregation
An event similar to a symposium

All GP consultations should be remote by default, says Matt Hancock

About should
The modal verbs of English are a small class of auxiliary verbs used mostly to express modality (properties such as possibility, obligation, etc.). They can be distinguished from other verbs by their defectiveness (they do not have participle or infinitive forms) and by their neutralization (that they do not take the ending -(e)s in the third-person singular).
The principal English modal verbs are can, could, may, might, must, shall, should, will and would. Certain other verbs are sometimes, but not always, classed as modals; these include ought, had better, and (in certain uses) dare and need. Verbs which share only some of the characteristics of the principal modals are sometimes called “quasi-modals,” “semi-modals,” or “pseudo-modals.”

He said it was patronising to claim that older patients were not able to handle technology.

The plan for web-based GP appointments is set to become formal policy, and follows guidance already sent to GPs on having more online consultations.

All GP consultations should be remote by default, says Matt Hancock

But the Royal College of GPs (RCGP) hit back, saying it would oppose a predominantly online system on the grounds that both doctors and patients benefited from proper contact.

Addressing the Royal College of Physicians in London, Hancock

noted the huge increase in online consultations as much of the NHS closed its doors to focus on the crisis. In the four weeks to mid-April, 71% of routine GP appointments were done remotely against 25% in the same period a year before.

Outlining what he said were the ways the pandemic had demonstrated the need for greater uses of technology in healthcare, Hancock said that before the coronavirus, “there was a view advanced by some which held that anyone over the age of 25 simply could not cope with anything other than a face-to-face appointment”.

He said: “Of course there always has to be a system for people who can’t log on. But we shouldn’t patronise older people by saying they don’t do tech.”

The rise in online consultations had been welcome, he argued, especially in rural areas. “So from now on, all consultations should be tele-consultations unless there’s a compelling clinical reason not to,” Hancock said.

“Of course, if there’s an emergency, the NHS will be ready and waiting to see you in person – just as it always has been. But if they are able to, patients should get in contact first – via the web or by calling in advance.”

Responding to the idea, Prof Martin Marshall, chair of the RCGP, said the organisation backed the idea of learning better ways of working from Covid-19, but expressed concern about a significant shift away from in-person consultations.

“A totally, or even predominantly, remote general practice service wouldn’t be in anybody’s best interests long-term, and throughout the pandemic face-to-face appointments have been facilitated when they’ve been necessary,” he said.

Remote consultations did have benefits, he said, but many patients needed physical examinations, vaccinations and the like, while a considerable number, particularly those with complex health needs, “really value the relationship-based care that GPs excel at delivering”.

Separately, the Royal Society of Arts, Manufactures and Commerce (RSA) pointed to research showing only 6% of over-55s had accessed any online health services amid coronavirus, against 25% of 18- to 34-year-olds.

In a lengthy speech, Hancock said the coronavirus outbreak had “tested every single part of our infrastructure” on health, likening it to “sheet lightning on a dark night” in revealing what worked and what did not.

“We must learn from how the NHS and social care worked during the peak,” he said. “Both about what we must change. And critically, because so many things went right, we’ve got to bottle the best.”

Other lessons Hancock outlined included giving more responsibility to all staff, cutting away “the barnacle-like encrustation of rules and regulations”, and better cooperation between different parts of the NHS.

Hancock, who did not mention data released on Thursday that showed England had the highest levels of excess deaths in Europe in the first wave of the coronavirus pandemic, also highlighted what he said was the vital role of preventive health.

In the past week, the government has launched a campaign intended to tackle obesity, and plans to help more people walk and cycle, thus becoming more active.

“Our NHS is a place where miracles are an everyday occurrence. But they cannot, must not, shoulder the whole burden of keeping the nation well,” Hancock said.

“The best evidence we have suggests that only about a quarter of what leads to a longer, healthier life is the result of what happens within a healthcare system. Prevention matters, as the pandemic has vividly shown.”