GPs warned NOT to default to virtual consultations – huge health row to erupt

Charley Webb urges fans not to put off visit to the doctors

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In an exclusive interview, ahead of a Royal College of General Practitioners report on the future of telemedicine to be released next week, Martin Marshall, Professor of Healthcare Improvement at University College London, spoke out amid growing accounts linking missed cases of deadly conditions such as cancer with a lack of hands-on diagnosis. Professor Marshall said while virtual consultations were necessary to protect staff and patients at the height of the pandemic, an evaluation of the “disadvantages and unintended consequences” of remote appointments is now needed before telemedicine is used routinely by family doctors.

He said while there may be a place for some virtual consultations in the post-pandemic world, the technical infrastructure was not advanced enough to support the widespread shift towards it which is being promoted by the Secretary of State for Health Matt Hancock and NHS bosses.

Professor Marshall said: “The use of remote consultations during the pandemic was necessary to protect staff and patients. However once safe it is time to shift back to face-to-face appointments which are far more important than some policymakers might suggest. Currently there are not enough face to face appointments and this is dangerous.”

He added: “We need better technical infrastructure to do telemedicine properly – there are parts of the country where there is not enough bandwidth to do properly for example. We need to properly evaluate the use of virtual consultations including the risks and unintended consequences. We are pushing this faster than evidence allows.”

Under NHS England guidance rolled out during the pandemic surgeries were encouraged to use more telemedicine including the use of eConsult – in which patients submit symptoms online – as well as virtual consultations either by phone or video. Professor Marshall said it is difficult to go against this guidance: “Local or regional managers will make it clear they are unhappy if practices do not follow the guidance on telemedicine.”

However, there have been increasing reports of deadly conditions including cancers being missed and some doctors have been unable to cope with the shift. Ivy Grove Surgery in Ripley, Derbyshire recently wrote a 16-page letter asking patients to use its service responsibly after being overwhelmed by a surge in patients using eConsult in the wake of the pandemic.

Professor Marshall said: “GP’s and patients are being set against each other, but doctors need to work with patients to challenge the government, lobby MP’s and policymakers to ensure we are not forced into using telemedicine where it is not appropriate.”

His comments are echoed by scores of Local Medical Committees who have expressed concern at the growth in telemedicine and the failure to ensure the technological infrastructure is “mature” enough to support it.

They have signed a joint letter to express their concern and the issue will be discussed to the annual Local Medical Conference next week. (12-13 May.)

Dr Peter Holden, a member of the British Medical Association’s GP committee said: “We are years away from the infrastructure being mature enough to support this and it is not all in the gift of the NHS as problems include poor internet connectivity.”

He added the growing use of telemedicine was also discriminating against those likely to need the most help. “Wealthier people with iPads who are tech-savvy are more likely to jump the queue than those with most clinical need.

“Opening up new virtual channels is like opening up another lane on the motorway – it just fills with more traffic. We haven’t the capacity to deal with it and eConsult has become a channel for those with sharp elbows and the greatest tech skills. We cannot do it this way. We are now seeing advanced pathologies that we haven’t seen in 30 years and a huge number of people with psychiatric disorders as a result of the lockdowns.

“You cannot assess this down a camera or a phone. Remote consultations are only as good as the tech skills of the person using them. Enough is enough. It’s time politicians wound their necks in.”

He added: “As GP’s we did not sign up to being call centre operators. It is stressful and hazardous. It doesn’t matter that the secretary of state is espousing the benefits of telemedicine. We have enough problems without adding that.”

Dr Ron Daniels, founder of the Sepsis Trust said: “With virtual consultations a significant part of the examination is undoubtedly lost. I’ve seen people presenting with sepsis in very severe states who found it difficult to get face-to-face access. It’s an assertiveness lottery and I’m sure it’s the same for other conditions like cancer. Over the pandemic we have seen where telemedicine has failed. We need to open our eyes, ears and hearts to the concept that telemedicine will fail some.”

Dr Renee Hoenderkamp, a GP and TV presenter said: “Some patients are less likely to talk about embarrassing symptoms unless they can see you and you build trust. A new mum might tell you she is doing fine over the phone but if they see you they may then share something important. Body language might tell you if someone is depressed or struggling with anxiety.”

Leading cancer specialist Professor Karol Sikora said: “We will see a huge rise in cancer deaths over the next year due to lack of face-to-face consultations and we are in danger of seeing more. Many consultations are complete trivia but within that trivia there is someone with something serious but the danger is you cannot examine people remotely.”

Dr Kailaish Chand, honorary Vice President of the BMA said: “Post covid a tsunami of patients who will come forward after being put off by the stay at home message and the restrictions of NHS services. The move by Matt Hancock to replace face-to-face with virtual consultations is a shortcut and will create problems. Things will be missed.”

At present approximately two-thirds of GP consultations are now face-to-face. In one recent survey more than half of GP’s said they want to establish remote consultations as the new fist line appointment after the pandemic.

In a speech on the future of healthcare for the NHS last summer Matt Hancock said remote consultations should continue post-pandemic.

A Department of Health and Social Care spokeswoman said: “Remote GP consultations have been essential throughout the pandemic to help ensure cases do not get missed, as well as face-to-face appointments which have continued where possible.

“This hybrid model helped protect staff and patients from avoidable risk of infection, reduces waiting times and provides quicker routes to diagnosis and treatment.

“Before COVID-19, approximately 3 percent of GP practices were capable of doing remote video consultations. Now thought to be at almost 99 percent, these new technological capabilities will play an important role beyond the pandemic.”

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