GPs told to switch to digital consultations to combat Covid-19

Millions of patients will have face-to-face appointments with their GP replaced by telephone or video consultations under NHS plans to respond to the threat posed by the coronavirus.

Guardian graphic

In a significant policy change, NHS bosses want England’s 7,000 GP surgeries to start conducting as many remote consultations as soon as possible, replacing patient visits with phone, video, online or text contact.

They want to reduce the risk of someone infected with Covid-19 turning up at a surgery and free GPs to deal with the extra workload created by the virus.

In a pre-emptive move some surgeries, especially in London, have already begun texting patients to tell them not to come in for pre-booked appointments from Monday and that appointments will be conducted by phone instead.

The approach could affect many of the 340m appointments a year with GPs and other practice staff, only 1% of which are currently carried out by video, such as Skype. The change could last for several months as experts believe the virus may not peak until April or May, and could last until June or July.

The move is likely to prove controversial because it will mean that many patients are unable to have a physical examination as part of their consultation, risking some symptoms going undetected.

The Royal College of GPs made clear that patients who still want to see a GP should be able to do so.

NHS England has started asking health technology firms such as PushDoctor, Babylon, Docly and Visiba to help surgeries put in place the equipment needed for a massive expansion in remote consultations.

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Many NHS hospital trusts have also started exploring how they could hold outpatient appointments by telephone or digitally as a way of coping with extra pressure they will come under if Britain’s outbreak becomes a pandemic, as senior doctors fear.

In a letter to GPs on Thursday to update them on its plans to counter Covid-19, NHS England told them to use phone or video consultations to assess people who may have contracted the virus as a way of protecting themselves.

“To mitigate any risk that potentially infected patients book appointments online and attend the practice when they should be receiving advice to self-isolate or go through testing, all practices are now being advised to change face-to-face appointments booked online to triage appointments via telephone or video,” wrote Dr Nikita Kanani, a GP and the NHS’s medical director for primary care.

Dr Steve Mowle, the RCGP’s honorary treasurer, said: “As a profession we will need to think about how best to consult with our patients during this period. We know some practices are ramping up the number of remote consultations they are offering, either online or by phone or video.

“That seems like a sensible measure, particularly for initial contact and for appointments that have been booked online. However, these types of consultations have limits, and won’t be suitable for all patients, so there will need to be some degree of flexibility.”

An NHS spokesperson said: “Anyone who is worried they have coronavirus should check with NHS 111 online, and for any other health concerns, it remains the case that people can see a GP in your local practice.

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“As a precaution to protect patients, staff and the public, appointments booked online may be followed up with a call by the surgery, to make sure they see the right person in the right place for their illness.”

Graham Kendall, director of the Digital Healthcare Council, which represents health tech firms, said: “Online consultations cancel the risk of patients transmitting coronavirus to their GPs, and vice versa. They are also much more convenient for patients and doctors in many cases. If just 5% of GP consultations went digital, there would be 300,000 fewer face-to-face visits to a GP a week – each of these could be a potential coronavirus transmission.

The World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the Wuhan coronavirus, for which there is no specific cure or vaccine.

The UN agency advises people to:

  • Frequently wash their hands with an alcohol-based hand rub or warm water and soap
  • Cover their mouth and nose with a flexed elbow or tissue when sneezing or coughing
  • Avoid close contact with anyone who has a fever or cough
  • Seek early medical help if they have a fever, cough and difficulty breathing, and share their travel history with healthcare providers
  • Avoid direct, unprotected contact with live animals and surfaces in contact with animals when visiting live markets in affected areas
  • Avoid eating raw or undercooked animal products and exercise care when handling raw meat, milk or animal organs to avoid cross-contamination with uncooked foods.

Despite a surge in sales of face masks in the aftermath of the coronavirus outbreak, experts are divided over whether they can prevent transmission and infection. There is some evidence to suggest that masks can help prevent hand-to-mouth transmissions, given the large number of times people touch their faces. The consensus appears to be that wearing a mask can limit – but not eliminate – the risks, provided it is used correctly.

Justin McCurry

“However, NHS Digital figures show that in 2019 less than one in every 100 of all GP appointments was carried out by online video consultation and nearly four in 10 people had no access to online consultations at all. This isn’t because of a lack of technology, but in many, many cases the decision has been taken not to offer this type of consultation to patients.”

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Push Doctor’s chief medical officer, Dr Dan Bunstone, a Cheshire GP, said: “We are ready and fully prepared to help the NHS – both GP practices and hospitals – to cope with the rising tide of demand for online NHS advice and can provide online video consultations at scale across the country immediately.

“We can also quickly and easily mobilise more GPs to hold remote consultations, and rapidly increase the number of daily appointments on offer to ensure that patients are still able to access GP services remotely.”


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