Andrew Haldenby is Director of Aiming for Health Success, a new health research body.
Speaking last week, Boris Johnson said that it is “only reasonable” that people can have a face-to-face appointment and that some patients will “suffer” otherwise.
The Prime Minister was responding to campaigns run by both The Mail and The Mail on Sunday. The Mail’s five-point manifesto calls for face-for-face appointments to be the default. Going further, The Mail on Sunday has demanded that “all patients are once again seen face-to-face by their GPs”.
Two days previously, Sajid Javid took a very different line. In a speech on the “power of technology”, the new Health Secretary said that while not everyone wants a virtual appointment, “some people do”. The benefits of this and other technologies are “enormous”. He concluded that “we need to give people choice, and take the opportunities that these new technologies provide”.
Javid followed the line taken by his predecessor. Last November Matt Hancock, the then Health Secretary praised GPs for updating their ways of working and allowing more telephone consultations which were convenient for many people. At that time 45 per cent of appointments were by telephone or video which, he said, “feels about right to me”.
The question has political interest because governments need consistent positions, especially on the most sensitive issues such as health. But more importantly than that, the Government’s support or opposition to change in the NHS will determine whether it can make any real progress on the backlog, without further tax rises, in the next few years.
The facts favour the Health Secretary over the Prime Minister. As the graph shows, face-to-face appointments have been the most common mode of consultation throughout the pandemic.
They have also been the most common mode in every month except for April, May and June last year, at the height of the first wave, when face-to-face and telephone appointments were equal. The Mail can call off its campaign – face-to-face remains the default mode of consultation.
Another key fact is the Government’s success or failure in recruiting new GPs. The Mail wants Ministers to honour the 2019 manifesto commitment to employ “6,000 more doctors in general practice”. It won’t happen.
In 2015 another Health Secretary, Jeremy Hunt, pledged to recruit 5,000 more GPs by 2020, on top of the then 27,500. Six years on, numbers have actually fallen to 26,800 as GPs have retired earlier or moved to part-time.
If the Prime Minister thinks that a small army of new GPs will soon arrive to take a new wave of face-to-face consultations, he is badly advised. The truth is that general practice is a limited resource that has to be used most effectively.
The very good news for Ministers is that general practice is in the process of taking a historic step forward in its ways of working. Traditional general practice had many strengths but also major weaknesses. GPs offered a ten-minute consultation regardless of patient need. Patients typically reported their medical history in the consultation which took up much of that time. GPs spent time with patients with relatively minor concerns who could have been better seen by nurses or other staff.
These barriers are being overcome. One key change is to use technology to capture a patient’s medical history in advance, over the internet. Patients now send two million of such “e-consults” to GP surgeries every month, up from around 100,000 before the pandemic.
This already makes much better use of GP’s time because they no longer have to spend time in consultations transcribing patient histories. In addition, current trials are using artificial intelligence to read that information and direct the patient to the right place – whether GP, another member of practice staff, pharmacy, A&E or self-care if that is appropriate. The realistic hope is that GPs can make significant clinical decisions on 12 or 15 patients per hour rather than six. This would solve the problems of delayed diagnosis that is a large part of the backlog problem.
Johnson may respond that this is all very well, but in the short term many people have been shocked by a shift in the GP offer that they weren’t expecting. In other circumstances, these new ideas would indeed would have been introduced over a longer time and with more reassurance. But if he lets these concerns become a veto on change, he will make it extremely hard for the Government to make progress on the backlog.
Javid has the right line. By far the best choice for the Government is to work together with GPs to reassure the public that face-to-face consultations are available and, crucially, that they want a different and better NHS to emerge post-pandemic rather than simply turning the clock back to December 2019. Making the case for change in public services is always a political challenge but in this case it is one well worth making.