Remote GP appointments are not “substandard”, the Royal College of General Practitioners has insisted after a coroner warned a lack of face-to-face appointments was linked to five deaths.
Alison Mutch, the senior coroner for Greater Manchester, said doctors were missing details in virtual appointments that could have been picked up if patients were seen in person.
In five separate prevention of future death reports, first reported by the Health Service Journal, Ms Mutch raised concerns about a patient with mental health risks being assessed over the phone, and another who could have been sent to hospital sooner for vital treatment if they were seen in person.
Prevention of future death reports are made by coroners to a person, local authority or government department if there is a risk other deaths could occur in similar circumstances.
Two of Ms Mutch’s reports have been sent to NHS England, which has until October to respond to her concerns.
Rachel Power, the chief executive of the Patients Association, said the reports were a “reminder” of the “important safety dimension to making sure patients get appropriate care, including a clear offer of face-to-face appointments”.
However, the Royal College of GPs said a “worrying narrative” had built up during the pandemic that “remote consultations are substandard, harmful to patients and are being used by ‘lazy’ GPs as an excuse for not seeing patients face to face in the surgery”.
GP face-to-face timeline
Prof Martin Marshall, the chairman of the Royal College of GPs, said: “As well as being inaccurate and untrue, this narrative in itself is harmful as it undermines public trust and confidence in remote consultations when thousands of patients are being assessed effectively and safely in this way in general practice every day – and have been since long before the pandemic.
“Remote care is not substandard, and GPs work incredibly hard to deliver the same high-quality care for their patients, whether a consultation is remote or face-to-face.”
In an interview with The Guardian, Prof Marshall said GPs are “finding it increasingly hard to guarantee safe care to their patients” due a shortage of doctors and surging demand.
“The chances of making a mistake in a diagnosis or a mistake in a referral decision or a mistake in prescribing are all greater when you’re under stress. And if you’re working 11-, 12-hour days, seeing 50, 60 patients… the chances of you making a mistake, we all know, are higher,” he said.
Analysis by the Royal College of GPs shows that the number of GPs working full-time hours fell by more than 1,300 between September 2015 and March 2021.
The NHS ‘is not perfect’
Dr Richard Vautrey, the chairman of the British Medical Association’s GP committee, said when patients do not get the care they need, “it’s a reminder that the NHS, though an incredible service, is not perfect and at times the system can fail”.
However, he added: “GPs take no pleasure in hearing when patients or their families feel they have been let down and the past 18 months have presented doctors and their patients across the NHS with some terribly difficult challenges.”
One of the cases which has been sent to NHS England for review is of Maurice Leech, who died in April 2020 after breaking his thigh bone. The hospital discharged him after failing to X-ray part of his leg. Mr Leech was later assessed over the phone by a GP, but by the time his fracture was discovered, he was considered unfit for surgery. He was discharged back to a care home but died shortly afterwards. A post-mortem listed the broken leg as a contributing factor to his death.
Ms Mutch said if he was physically examined, he would have been sent back to hospital quicker.
An NHS spokesman offered their condolences to the families affected, adding: “Every GP practice must provide face-to-face as well as telephone and online appointments and continuing to offer all of these methods of consultation is part of making primary care as accessible as possible.”