The changing face of general practice and online primary care
Primary care is the first port of call for most people needing health care and it has brought about huge changes in the way it works in the face of the challenges of coronavirus (COVID-19).
GP practices and other primary care services have made an impressive transformation in response to the pandemic to continue to support the needs of people in the community.
Our inspection teams have noted:
- a fall in the number of face-to-face GP appointments and a rise in those conducted remotely, especially by phone and email
- changes to prescribing, with more medicines being prescribed for longer periods of time
- digital systems becoming more available, include mechanisms for patients to send information to practices as well as arrangements for video consultation
- practices rapidly adapting to the use of technology – accelerating the intention behind NHS England's Digital First Programme.
Feedback from services
In initial feedback from conversations we have had with GP practices in the course of our regulation, they said that practice teams have been working well together and more closely in response to the challenges they have faced, which has enhanced people’s working relationships.
They have said that the switch to remote consultations by phone and video has been working well, and there has been positive feedback from clinicians and patients.
Practices have also indicated that they had received good support and engagement from others to help them manage the pandemic, including clinical commissioning groups and primary care networks.
In terms of the challenges they have faced, a common theme in early feedback was one of information overload, particularly practices struggling with guidance from different sources that was changing or conflicting. Practices have said that going forward, guidance needs to be much better coordinated and streamlined.
New ways of working
During March, general practice increasingly moved to new ways of working, including implementation of ‘total triage’ and online/remote consultation.
NHSX reported that, by 1 June 2020, 87% of general practices were live with technology to enable online consultations, a figure that has increased markedly during the COVID-19 period. NHSX also reported that more than two-thirds of practices saw appointments booked online using GP Connect.
However, GP practices’ own systems haven’t fully reflected this rapid shift in ways of working and the increasing use of online or video conference to deliver appointments. The recording of GP activity is still at the experimental data stage. The data generally only count appointments delivered via traditional modes of delivery, which recorded a sharp fall around the time of the lockdown, with an increasing proportion delivered as telephone consultations: 1.34m appointments on Monday 2 March, of which 15% were recorded as being by phone; and 0.93m appointments on Monday 30 March, a week after the lockdown, of which 46% were recorded as being by phone. During April, however, the number of appointments delivered via traditional modes, including the proportion of face-to-face appointments, had started to rise.
At the same time, there were more than a million extra calls to NHS 111 in England, in response to the public campaign to highlight the need to contact 111 first with any concerns. Calls almost doubled in March compared with preceding months, before falling back to more normal levels in April.
Source: NHS Digital, Appointments in General Practice, March and April 2020
Source: NHS England, NHS 111 Minimum Dataset
Impact on referrals
Primary care services have responded by increasing remote consultations and have remained open. There have been fewer booked appointments taking place overall. There have been falls in referrals onto the 18-week pathway, in patients seen in hospital on the two-week cancer pathway, in CAMHS referrals, and in A&E attendances. It remains unknown what this might mean in terms of any increased short and long-term risks to people’s health in the general population.
The impact may include:
- missing early identification of serious illnesses, including cancer
- difficulties in managing long-term conditions effectively
- the potentially lower uptake of childhood immunisation.
Source: NHS England