Remote GP consultations during the first COVID-19 lockdown have been deemed a success – but may need to change in a post-pandemic environment, according to a new study.
Researchers from the Centre for Academic Primary Care at the University of Bristol and National Institute for Health Research (NIHR) found 90% of GP consultations were via telephone, video or online in April 2020, compared with 31% in April 2019. Nurses carried out remote consulting 46% of the time during the first phase of the pandemic. Writing in the British Journal of General Practice, the authors say the rapid shift to remote GP consulting was successful and medical staff were able to continue focusing on vulnerable patients, but indications are that this must be adapted in a post-pandemic world.
Dr Mairead Murphy from the Centre for Academic Primary Care, who co-led the study, said: “The NHS long-term plan mandates a move to remote consulting and this change was accelerated by the COVID-19 pandemic.While pre-COVID-19 research established that telephone and video consultations were effective and safe, it was done in the context of remote consulting implemented for certain patients and conditions. Our study shows some limitations with remote consultations and suggests that remote GP consulting should be offered as one of a range of options, not by default. Post-pandemic we believe the model will need to be adjusted.”
The Rapid COVID-19 Intelligence to Improve Primary Care Response (RAPCI) study questioned doctors, nurses and practice managers at 21 surgeries, collectively with 350,966 patients, in Bristol, North Somerset and South Gloucestershire, to establish how they coped from April to August 2020. By July 2020, GPs were doing 85% of consultations remotely and nurses 38%, while GP-to-patient phone text messages increased three-fold, and nurse-to-patient almost five-fold in April to July 2020 compared to 2019.
The study found GPs and nurses maintained their focus on the most vulnerable patients throughout and that consultation rates did not reduce for those who were older, shielding or had poor mental health. It also found as overall consultation rates returned to normal in July, and complexity increased, some GPs found high levels of remote consulting a strain because it was more time consuming, with doctors saying they missed face-to-face contact and were concerned about clinical risk.
Co-study author Dr Jeremy Horwood, from the Centre for Academic Primary Care at the University of Bristol and NIHR ARC West, said: “GP practices have had to rapidly adopt new ways of delivering care remotely and responding to the new norm of social distancing to reduce the risk of COVID-19 infection. This is a huge change, with GP practices and patients having to transform the way they interact overnight. While remote methods of consulting may have value for some patients, such as straightforward medical enquiries, they cannot replace face-to-face consultations in situations which are more complex.”