Calderdale Council’s Adults Health and Social Care Scrutiny Panel recently called in GPs and Calderdale Clinical Commissioning Group about the public’s problems with getting appointments and advice from their GP surgeries, since the “total triage approach” was adopted in March 2020 on NHS England’s instructions.
A report by Debbie Robinson, Calderdale Clinical Commissioning Group Director of Improvement (Community and Primary Care), informed the 15th July meeting that,
“All practices introduced telephone triage which meant that patients were assessed by a Clinician over the telephone first, allowing many patients to be offered a consultation and potential treatment through a prescription or referral without the need for a face-to-face appointment.”
Widespread public complaints about not being able to get through to GP Practices’ phones
But from what was said in the meeting by Cllr Barnes, Calderdale Clinical Commissioning Group GP Lead Majid Azeb and Calderdale Local Medical Committee Chair Dr Seema Nagpaul, it seems that the initial phone triage assessment is carried out by receptionists who are unlikely to be clinicians.
Cllr Mike Barnes told the 15th July meeting that all Councillors had received many complaints from the public over the past year about being unable to get through on their GP Practices’ phones.
And when they could, they were “interrogated” about their symptoms and asked sensitive questions by receptionists whom they didn’t know. The receptionists wouldn’t put patients through for a consultation until they’d,
“got the answers on their tick sheets.”
Cllr Barnes added that Practice Managers’ responses to this issue had been patronising, condescending and hadn’t addressed the issue.
Majid Azeb, the GP lead for the Clinical Commissioning Group, told Cllr Barnes that because nowadays GP practices have so many different types of staff, they need receptionists to get an indication of what the problem is so they can put the patient with the correct clinician, as a start. But this should not involve interrogation.
Dr Seema Nagpaul said that in training they should be looking at the way receptionists ask for patients’ details in the initial telephone triage – they never used to do that.
Majid Azeb said that the responsiveness of General Practice has improved with the new total triage system. Instead of waiting 2 weeks for a routine appointment, 95% of patients now have a call back on the same day. And this is on the highest level of appointments since NHS Digital started collecting data.
He said a lot of people like the convenience of the new phone system and the CCG has invested in phone systems for GPs, with practices employing more admin, reception and clinical staff to manage this.
NHS Digital sits on data the Clinical Commissioning Group needs
Cllr Barnes asked if there was any breakdown by GP Practices of the report’s chart about different types of Calderdale GP appointments – face to face, telephone, video conference/online, home visit.
Debbie Robinson told him that they don’t have this data because the data provided by NHS Digital on behalf of NHS England is only at CCG level.
Ideally the Clinical Commissioning Group want more data and they also want data about patients’ access to Primary Care Network physiotherapists, care navigators and prescribing pharmacists, which they don’t get. That data’s not included in the chart, so it doesn’t show the full access to primary care clinicians.
(It seems from a Primary Care Commissioning report that the limitations of NHS Digital data on GP appointments are also due to
“the wide variation in recording between practices, driven by the use of multiple IT systems and different recording approaches in practices.”
GP Practices had until 30th June to fix this. If you’re interested in this detail , you can download more information here):
How does Joe Blogs down the street with no digital technology access his GP surgery to get the best possible healthcare?
Cllr Blagborough said he appreciated the work that GPs were doing, but the Scrutiny Panel needed to commission a report for Joe Blogs down the street who doesn’t have digital technology. How does he access his GP surgery to get the best possible healthcare?
Neil Smurthwaite, Chief Finance Officer and Deputy Chief Officer, told Councillors that the Clinical Commissioning Group need help to manage people’s expectations, because
“There are unparalleled demand and asks… across all levels of health and social care but…there aren’t enough people to deliver everything…We have to talk as a commissioning system about what people’s expectations can be.”
Cllr Blagborough replied that the Council was willing to help with better communications for the public, adding,
“And yes, there is a higher demand, but they need to know that when they knock on a doctor’s door they can actually physically see somebody that they need to see.”
The sadness as a GP
Calderdale Local Medical Committee Chair, Dr Seema Nagpaul, lamented the loss of traditional GP practice, seeing patients face to face with continuity of care that extended over generations. She said patients used to love that, and,
“That’s what a lot of us remember and what a lot of us would want. The sadness as a GP is that that’s not what a GP is any more.
“The way we practice medicine’s changed, the way we’re asked to practice by NHS England has changed and GP practice isn’t going to go back to what I used to really love and what the patients did…
“I can see where patients are coming from…Patients don’t think of a phone consultation as seeing us, because they don’t see us. The way we manage primary care is different. It doesn’t mean it’s worse, just different.
“Someone somewhere needs to get a grip on this”
Cllr Colin Hutchinson pointed out that phones are going to be the main means of contact with primary care services for some time to come. The correct capacity of phone lines and people is vital, so people aren’t left hanging on for 40 minutes or an hour, waiting to actually get through.
He wanted to know if this is the responsibility of individual practices, Primary Care Networks or the Clinical Commissioning Group, because
“someone somewhere needs to get a grip on this.”
Neil Smurthwaite said phones are a requirement for GP practices to deal with and there has been investment in upgrading phone systems. The Clinical Commisioning Group works collaboratively with Primary Care Networks and Local Medical Committees to encourage practices to work “at scale” – meaning at the level of Primary Care Networks. But they can’t commission them to do that.
NHS England has now withdrawn the March 2020 document that instructed GPs to reduce face-to-face contact with patients and adopt total triage to limit the spread of COVID-19 at the outset of the pandemic.
Despite the withdrawal of the Standard Operating Procedure document, NHS England makes clear in its 19th July letter to GP Practices that they,
‘should continue to offer a blended approach of face-to-face and remote appointments, with digital triage where possible’.