Patients seen face to face by GPs upon request, finds NHS England

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GP consultations tend to ‘be delivered in line with patient preference’, meaning that those requesting face-to-face appointments are ‘more likely to have one’, NHS England has found.

A new study, led by NHS England and the Health Foundation, examined more than 10 million patient-initiated requests for general practices services at 154 practices between March 2019 and February 2022 using a modern general practice access model, including both digital and non-digital access pathways.

It analysed trends in requests for services and the association between patient characteristics including demographics, preferences for care and clinical needs and modes of patient contact (online vs telephone), and care delivery (face-to-face vs remote) at practices using a modern access model.

The report, published in the BMJ, said: ‘Before Covid, patients with a preference for continuity of care were less likely to be seen face-to-face than those that did not, but after 2020/2021, the trend reversed.

‘Consultations tended to be delivered in line with patient preference—those requesting a face-to-face consultation were significantly more likely to have one compared with those who requested an online or telephone consultation.’  

The study pointed out that ‘only a minority’ of requests at these practices indicated a preference for a face-to-face consultation.

It added: ‘Importantly, mode of contact did not determine how care was delivered.

‘Face-to-face consultations were more likely to be used by clinicians for the youngest and oldest patients, those asking about new medical problems, non-frequent attenders (likely to be less familiar to the practice), a preference for continuity of care (during the pandemic) and a preference for face-to-face consultation.

‘These findings are consistent with other evidence suggesting that face-to-face consultations are more likely to be used for the most vulnerable or complex patients.’

The authors concluded that from a patient perspective, ‘modern general practice access may enable greater flexibility better matched to individual circumstances and support patient-centred care’.

Professor Azeem Majeed, head of the Department of Primary Care & Public Health at Imperial College London, said that the study showed a flexible patient behaviour, which could inform policy.

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He told Pulse: ‘The study suggests that a blended model of digital and non-digital access does not disenfranchise non-digital users, an essential point for NHS staff concerned about health inequalities.

‘The study also showed patient behaviour is flexible; they will choose the medium (digital or in-person) based on the urgency and type of the problem.

‘This flexibility could inform policy, encouraging a more adaptable primary care system. The study underlines the importance of a modern, multimodal, and flexible general practice model that can adapt to the evolving needs and preferences of the UK population.’

Dr Steve Taylor, a GP in Manchester and GP spokesperson for the Doctors’ Association UK (DAUK), told Pulse: ‘All GPs would probably prefer to offer appointments in line with patient request and preference.

‘The harsh reality of lower numbers of GPs, with numbers of patients per GP rising from 1,800 to 2,300 on average, is it is increasingly difficult to meet patient requests and preferences.

‘It is interesting to note that many patients prefer online/text and telephone consultations. GPs will call many of these people in for a face to face appointments knowing that this will actually be better for patient care.

‘Sometimes a telephone call from a doctors that knows you and your condition well is better than a face to face appointment with someone new to you.

‘We are in a tricky time of balancing the needs and desires of patients, with what realistically can be provided by the reducing number of GPs.’

Last month, a Pulse survey revealed that around 60% of GPs say they are able to offer face-to-face appointments to patients with similar waiting times to remote consultations.

At the time, NHS Digital figures showed there were more than 29 million appointments in June 2023, 20 million of which were face to face.

Meanwhile, a Pulse analysis earlier this year showed that practices that offered a higher proportion of appointments face to face had longer waiting times and a greater percentage of appointments with non GPs.

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