Thread by @EdTurnham

Early thoughts on today's @NHSEngland guidance on GP access: a short thread🧵
england.nhs.uk/coronavirus/wp…

The guidance assumes that it is inappropriate for less than 20% of GP appts to be F2F (face-to-face).

I'd be fascinated to see the evidence that shows this is inappropriate. Unfortunately there is no reference to such evidence in this document.

It seems bold to imply, on the basis of this assumption, that a large proportion of practices (over 15%) are offering 'wholly inappropriate access'.

Very recently the government actively promoted models of GP care with similarly low levels of F2F.

https://twitter.com/CharlesTTHF/status/1448540957566251008?s=20

@NHSEngland continues - rightly - to encourage practices to take advantage of the efficiency benefits that come from using non-F2F methods of care.

https://twitter.com/EdTurnham/status/1443674512755765249?s=20

Last year, @NHSEngland told practices to record more interactions with patient as appointments. Many of these interactions, such as phone calls to discuss results or text messages, would not previously have counted as 'appointments'. england.nhs.uk/wp-content/upl…

By faithfully following the guidance & recording all of these remote 'appointments', practices reduce the proportion of recorded GP appointments that are F2F. This now opens them up to criticism for not doing enough F2F appts.

When you give patients a choice of a F2F, phone or online response from a GP, very few choose F2F. I can imagine that many GPs are working appropriately with a F2F ratio under 20%, if they record all remote interactions as appointments.

https://twitter.com/askmygp/status/1313139404047888391?s=20

ICSs (or CCGs) now have 10 working days to identify which practices are providing this 'inappropriate care'. This will be challenging, to say the least. CCGs may not all have access to GP appointment data. This data is very poor at showing whether the appointment was F2F.

In short, I worry that practices that have followed all the @NHSEngland guidance over the last 2 years, and striven to provide the most effective model of care for their patients, will now be told off for doing so.