More than 700,000 patients could be left without access to face-to-face GP appointments

Hundreds of thousands of patients living in the poorest areas of the UK could miss out on face-to-face GP appointments due to Covid precautions, a report has warned.

NHS guidance urges all GPs who are at high risk of the coronavirus themselves to move to online or phone consultations for the safety of their own health and their patients’.

Family doctors deemed high risk are normally over-50, from a black, Asian or ethnic minority (BAME) background or suffer from a co-morbidity themselves.

Research by the Health Foundation charity estimates one in three GPs who run their own surgery fall into this category, meaning the entire practice could have to close.

Doctors running their own surgery single-handedly are also three times more likely to operate in areas with high deprivation, according to the charity.

In total, the Health Foundation estimates that 710,043 patients will miss out on the in-person appointments due to the volume of GPs deemed at risk of Covid. It found at least 8 per cent (3,632) of family doctors fell under this category. 

Experts say face-to-face appointments are critical because doctors can pick up on subtle symptoms and patients often feel comfortable enough to disclose more specific information about their health troubles.

It is feared some of this nuance is being lost through cyber visits, which consist of either a telephone call or video chat. 

Last Friday, Health Secretary Matt Hancock threw his weight behind much greater use of remote appointments, dismissing those concerned as simply being ‘naysayers’. 

Hundreds of thousands of patients living in the poorest areas of the UK could miss out on face-to-face GP appointments due to Covid precautions, a report has warned (file)

Hundreds of thousands of patients living in the poorest areas of the UK could miss out on face-to-face GP appointments due to Covid precautions, a report has warned (file) 

NHS England has ordered all of its frontline staff to be Covid-19 risk-assessed, with factors like age, sex, ethnicity and BMI all taken into consideration.

Nurses and paramedics who are put in this category are either moved to areas where infection rates are low, while GPs are told to move to online consultations. 

Across England, at least 8 per cent (3,632) of GPs are deemed at ‘high risk’ of death from Covid-19. 

Analysis by the Health Foundation estimates that one in three (32.7 per cent) GPs who single-handedly manage a GP practice fall into the category.

Just 1 in 10 GP appointments are now face to face as patients fear cyber visits are here to stay

Only one in ten GP appointments is face to face – three months after ministers vowed to get the NHS back to normal.

A major survey found 61 per cent of consultations are via phone call, 6 per cent through text or email and 4 per cent by online video.

Telephone triage assessments and home visits account for another 18 per cent, meaning that only 11 per cent of consultations led to direct contact at a surgery.

Yet in late April – as coronavirus cases tailed off – Matt Hancock promised to restore regular NHS care.

And today the Health Secretary will announce major plans for future working, including proposals for doctors to contact patients on WhatsApp.

Mr Hancock will also promise to slash bureaucracy and let staff work more flexibly so they stay in their jobs for longer.

The survey by the Royal College of GPs involved 859 family doctors and was carried out over the two weeks to last Wednesday.

If the results are a true picture of the UK as a whole it means patients are three times more likely to receive a text or email from their GP than a home visit.

As many as 88 per cent of doctors said their surgery was offering video or online consultations compared with 5 per cent before the pandemic.

Seven in ten said telephone appointments increased their efficiency, rising to 76 per cent when asked about telephone triage.

These family doctors are more than three times as likely to be working in the most deprived regions, which risks worsening health inequalities already exacerbated by Covid-19, the charity said

The analysis also found that London may be particularly affected if GPs at high risk from the disease restrict their patient-facing activities. 

The capital has the highest proportion of GPs at very high risk from Covid and of single-handed GP surgeries run by a GP at very high risk. 

The Health Foundation is calling for CCGs to make sure all patients have access to face-to-face appointments if they need one. 

Dr Rebecca Fisher, senior policy fellow at the Health Foundation and practicing GP, said: ‘The ongoing risk of Covid-19 to the safety of both patients and GPs means that hundreds of thousands of people may find it much harder to get a face-to-face GP appointment. 

‘It’s particularly worrying that GPs at higher risk from Covid-19 are far more likely to be working in areas of high deprivation.

‘Those are precisely the areas with the greatest health need, the biggest burden from Covid-19, and an existing under-supply of GPs relative to need.

‘Unless urgent action is taken this could become another way in which poorer communities become further disadvantaged, and risks further widening health inequalities.’ 

The report comes just days after a retired taxi driver ended up in hospital with a serious infection after being denied a face-to-face GP appointment under Covid-19 ‘safety’ rules.

Since March, most GP surgeries have radically cut down on face-to-face consultations in a bid to reduce coronavirus spreading. Doctors phone patients instead, often from their own homes.

Few surgeries have resumed normal service and some remain closed, despite the virus dropping to low levels in many areas.

Lisa King, 54, from Brentwood in Essex, feared the arrangements could have been fatal for her husband Peter, 62.

Three weeks ago she emailed their surgery requesting an ‘urgent face-to-face appointment’ for Peter.

He’d had ongoing pains for weeks, his stomach was ‘bloated and tender’ and he had just been ‘violently sick’. She was worried it was cancer.

Deal Tree Health Centre emailed back the following day saying ‘on this occasion’ they would grant Mr King a telephone GP consultation, which took place that day.

After asking a series of questions, the GP said Mr King probably had acid reflux and prescribed a drug. The doctor told him to get back in touch in a week’s time if he had not improved.

Lisa King (pictured right), 54, from Brentwood in Essex, feared the arrangements could have been fatal for her husband Peter (pictured left), 62

Lisa King (pictured right), 54, from Brentwood in Essex, feared the arrangements could have been fatal for her husband Peter (pictured left), 62

But Mr King did not improve and the following Sunday his condition markedly worsened. Mrs King called 999 and an ambulance arrived within 20 minutes. She recalled: ‘Peter was in so much pain he was crying. When the paramedics got here, one ask him where it hurt and suggested a physical examination. As she moved to do so, Peter flinched. She then said, “Right, you need to go to hospital immediately.”’

At Queen’s Hospital in Romford, doctors found a gall stone lodged in his bile duct and his gall bladder badly infected and inflamed.

Mrs King recalled: ‘We were told if it had been left much longer, his gall bladder would have ruptured and caused systemic sepsis, which can be fatal. If he’d seen a doctor six days earlier, the GP would have known something was wrong – that it wasn’t just indigestion. You can’t diagnose something like this over the phone.’

She warned: ‘People will die if this lack of face-to-face consultations continues. And I don’t know why surgeries are not re-opening. Does anyone? Because I can go and get my hair done. You can go to the pub, and the gym too.

‘All those places have had to invest in PPE for their staff. Doctors are part of the NHS – they’ve got PPE provided for them. So what are they afraid of?’ Mr King has had an operation to remove one gall stone but may need more surgery for others found in his gall bladder. He has also been diagnosed with an inflamed pancreas, and been told the delay in surgery probably made matters worse.

The telephone consultation was ‘not good enough’, he said.

The symptoms I was displaying required a physical examination by a GP to determine accurately what was wrong with me.’

The doctor had appeared ‘terse’ and ‘dismissive’, he said, ‘which I presume was because he thought it was only indigestion’. 

Mr King said: ‘It seems to me that GPs are establishing a “new normal” behaviour for themselves, of phone consultations. I think it needs to be addressed before it gets out of hand.’

Last night, Dr Ken Wrixon, of Deal Tree Health Centre, said: ‘We hope Mr King makes a speedy recovery, and encourage him or his wife to get in touch with us so that we can look into this further.

‘While face-to-face appointments are available at the practice, to help keep people safe we’re offering telephone appointments with our GPs in the first instance, but encourage patients to get back in touch if they feel their condition has got worse so we can reassess whether their care needs have changed.’

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