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A return to face-to-face appointments by default will mean longer and longer waits to see a GP

At the start of the COVID-19 pandemic, GP practices were instructed by NHS England to move our default access channel to telephone and video consultations for the purposes of infection prevention and control.

However, it has emerged that this system of "total triage" can have an important function in ensuring that patients receive the most appropriate care at the most appropriate time.

I took a call from a lady who was concerned that a skin blemish may be cancerous. An hour later she was sitting in front of me being examined; an hour after that she received a call from the local hospital in response to my urgent referral for her skin cancer.

In the previous system of access, whereby every consultation took place face to face by default, and for which there were often waits of two, three, or even four weeks, this response would have been impossible.

Conversely, minor ailments and queries are very frequently dealt with, wholly appropriately, by telephone or e-mail – in every case saving a face-to-face appointment for a patient who really needs it.

As we gradually emerge from the COVID-19 lockdown restrictions, many are calling for a return to face-to-face appointments by default. However, our workforce is in crisis. The current government's pledge to increase GP numbers by 6,000 by 2024 is palpably failing – a net increase of 111 is a sorry testament to that empty promise.

A return to face-to-face consultation also means a return to longer and longer waits to see a GP, and a profession which is pushed yet closer to the precipice of crisis and collapse.

The use of telephone and online triage is currently the only tool we have which can direct the increasingly scarce resources in general practice to those most in need of them – and until our government produces the missing 5,889 doctors it says we need, we have to keep using it.

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Dr Nick Jackson

Dr Nick Jackson was born and brought up in North Yorkshire; he has been a full-time GP at Beech Tree Surgery in Selby since 1998. He has interests in diabetes and minor surgery as well as teaching medical students and junior doctors. He is Clinical Director for the Selby Town Primary Care Network (PCN). Here he discusses how the "total triage" system of managing demand for appointments can help ensure swift treatment for those who need it most.

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