A letter from the NHS has ordered all GP practices to offer their patients face-to-face appointments, following the easing of lockdown restrictions.

The letter states that during the pandemic, in-person general practice appointments were cut by half, and now that life is returning to some semblance of normality, GPs must ensure general practice does not become a “totally, or even mostly, remote service”.

The use of video, online and telephone consultations are still permitted, but there must be a “clear offer of appointments in person”.

Clinicians are advised to respect patients’ preferences for face-to-face appointments, unless there are good clinical reasons on the contrary; this includes if the patient has Covid-19 symptoms.

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The BMA have dubbed the letter “tone deaf”

The instructions have sparked outrage across the sector, with the British Medical Association dubbing the letter “tone deaf”.

Dr Richard Vautrey, BMA GP committee chair, said: “In the face of social distancing and infection control restrictions, practices should be commended, not condemned, for providing more than half of their appointments face-to-face.

“Even as restrictions ease, Covid is still circulating and new variants remain a concern, so to continue protecting patients, we have to limit how many can be in the surgery at any one time – something even NHS England note in its guidance.”

He continues: “Practices in England are delivering more than a million appointments each day, as well as now beginning to manage the huge backlog of patients who did not receive the care they needed because of the pandemic. This ‘invisible’ waiting list is just as real as the record number of patients waiting for hospital treatment – many of whom will also return to their GP for ongoing care.

“Add to this the Covid-19 vaccination programme, the fact we have nowhere near enough GPs and practice nurses, and that those we do have are exhausted. NHSE and the Government owe practices a huge debt of gratitude, not a public rebuke for ultimately doing what they were instructed to do.”

The RCGP have warned against returning to the ‘total triage’ model

The new guidance has been delivered as the Royal College of GPs (RCGP) warned against returning to the ‘total triage’ model, which has been in place since the pandemic began.

The total triage model worked by assessing the patient’s condition via telephone or online appointment, and deciding from there whether a face-to-face appointment was necessary.

The RCGP have warned that the digital triage system could become a ‘barrier to care’, by being overly complicated, and therefore exacerbate health inequalities.

For this reason, the RCGP advise that remote consulting should be an option, but not the ‘automatic default’ for GP care once we are out of the pandemic.

"Practices need to be trusted to deliver the care for their patients as they know best"

For clinicians, the advice has been conflicting and confusing. Just a few months ago, the health secretary Matt Hancock repeatedly called for more consultations to be carried out remotely, saying that delivering 45% of GP consultations remotely felt “about right”.

The Bedfordshire, Buckinghamshire and Oxfordshire (BBO) LMC have said the NHS letter has fuelled the spread of misinformation and painted GPs in a negative light, implying that GP practices have somehow been “closed” to face-to-face consultations during the pandemic.

Ultimately, it seems GP practices simply want to be trusted with making the best decision for their patients. In a response to the NHS letter, the BBO LMC wrote: “GPs and their staff are exhausted and beyond breaking point. The constantly changing, contradictory and whimsical demands from the NHS system leaders has to stop and it has to stop now. Practices need to be trusted to deliver the care for their patients as they know best.

“Our advice to practices, therefore, is that all NHS England guidance is non-contractual and guidance only. We remind practices that they are free to ignore any such guidance if they feel it is unhelpful to the safe and effective delivery of their services and we further remind practices that their contractual obligation as per the GMS Regulations laid out in statute is to “meet the reasonable needs” of their patients “in the manner determined by the contractor’s practice in discussion with the patient.”