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‘Total triage’: what new NHS guidance means for patients

Critics say remote consultations must not become the ‘default’

Doctors have been told to discourage patients from seeking face-to-face appointments and instead promote the use of virtual consultations in new NHS guidelines.

GPs are to implement a system of “total triage”, which means anyone wishing to see their doctor must first have a consultation online or by telephone, reports The Telegraph

The Royal College of GPs has expressed reservations about the plans, with its chair, Professor Martin Marshall, saying the college does not want to see “general practice become a totally, or even mostly, remote service” after the pandemic, reports GPOnline

The new plans, formalised into NHS operational planning advice last month, says anyone deemed by a doctor to require a face-to-face consultation should receive one, but “about a third of all patients’ requests can be dealt with using online messaging”, reports The Telegraph. 

Before the pandemic, 70% of appointments were face-to-face and the remaining 30% were via phone, video or online, but during the crisis, these figures have “switched” with just 30% of appointments being conducted face-to-face while 70% were remote, reports the Daily Mail

Doctors fear that this temporary solution to the coronavirus crisis, introduced to cut the spread of infection, will now become permanent, with a report from the Royal College of GPs warning that while remote consultations will remain a “major element” of general practice, it must not become the “default” option. 

The report pointed to the benefits of remote care, such as offering patients flexibility, but said online or phone consultations were “challenging” for GPs who were trying to treat patients with “complex health needs”. 

It added that remote consultations meant “softer” health cues could also be missed. 

It said: “In some cases, non-verbal or ‘soft’ cues such as signs of anxiety, self-harm, or smelling alcohol on a patient’s breath, may be more easily missed remotely, or there may be concerns about a patient’s safeguarding, capacity or confidentiality.”

Some 63% of GPs in a poll said delivering all or mostly remote consultations reduced their job satisfaction and 61% said remote consultations are making the role more transactional, reports the Daily Mail.

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