Remote general practitioner consultations during COVID-19
Authors: Mark A Green, Martin McKee, Srinivasa Vittal Katikireddi
Journal: The Lancet Digital Health (2021)

In a reversal of messaging before the COVID-19 pandemic, when ministers were encouraging an increase in the numbers of online health consultations, politicians have since demanded that general practitioners (GPs) in England reverse the shift to remote consultations that occurred during the pandemic. Supported by sections of the media, politicians are threatening to "name and shame"1Fisher L Roberts L GPs 'named and shamed' if they fail to see patients face to face.https://www.telegraph.co.uk/news/2021/10/13/gps-named-shamed-fail-see-patients-face-face/Date: Oct 14, 2021Date accessed: October 22, 2021Google Scholar or restrict new funding to GP surgeries that do not provide a sufficient number of face-to-face consultations. Advances in digital technology had already stimulated debate on consultation methods; despite offering convenience for some patients, there were concerns about widening inequalities for others.2Cookson R Propper C Asaria M Raine R Socio-economic inequalities in health care in England.Fiscal Studies. 2016; 37: 371-403Crossref Scopus (76) Google Scholar, 3Charles A Ewbank L The road to renewal: five priorities for health and care.https://www.kingsfund.org.uk/publications/covid-19-road-renewal-health-and-careDate: July 16, 2021Date accessed: October 22, 2021Google Scholar Given that the pandemic offered a natural experiment to assess the potential implications of remote consultations, we analysed data from NHS Digital to better understand these implications.4Green MA Katikireddi SV Trends in remote GP consultations for England.https://github.com/markagreen/remote_GP_consultationsDate accessed: October 22, 2021Google Scholar Our analyses showed that any suggestion that GPs were not seeing patients in person was not true. Although the number of face-to-face appointments in England decreased from 8 758 600 in February, 2020, to 2 783 535 in April, 2020, they have since increased by 89% (5 248 932 in August, 2021). Simultaneously, telephone consultations almost trebled during this period (from 2 203 203 in February, 2020, to 6 221 869 in August, 2021). Despite how most consultations are now conducted remotely (appendix p 1), the growth in remote consultations has allowed for a substantial increase in the number of overall consultations, compared with pre-pandemic levels. Patients value prompt consultations and GP surgeries are responding accordingly (appendix p 1). For example, the percentage of patients seen on the day that they contacted their GP increased between February, 2020 (58% overall, 51% for face-to-face consultations, and 63% for remote consultations), and April, 2020 (78%, 77%, and 79%, respectively). The number of same-day in-person consultations is higher than that reported before the pandemic (58% in August, 2021, vs 51% in February, 2021). But what happened to existing inequalities? Before the first national lockdown, patients in regions with more deprived populations were less likely to use remote consultations (monthly correlation coefficients ranged from –0·57 in March, 2019, to –0·59 in February, 2020). Following this lockdown, any association disappeared (coefficients ranged from 0·01 in April, 2020, to 0·17 in August, 2021). Although patients in more deprived areas were less likely to receive same-day remote consultations before the pandemic, this gradient has also disappeared during the pandemic (appendix p 1). Remote consultations are improving access to primary care, enabling GPs to see patients who need face-to-face appointments more quickly. GPs are best placed to understand the needs of their patients and remote consultations offer safety during a public health crisis. Given that England has one of the highest prevalence rates of COVID-19 in Europe,5Pagel C McKee M Why is England doing worse against Covid than its European neighbours?.https://www.theguardian.com/commentisfree/2021/oct/07/england-vaccine-just-plus-europe-covidDate: Oct 7, 2021Date accessed: October 22, 2021Google Scholar remote consultations will continue. Nevertheless, debate about the role of remote consultations should be based on evidence, not anecdote. MAG acknowledges funding for this research from UK Medical Research Council (MR/W021242/1). SVK acknowledges funding from a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). Download .pdf (1.44 MB) Help with pdf files Supplementary appendix