Early thoughts on today's @NHSEngland guidance on GP access: a short thread🧵
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.

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

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More from @EdTurnham

30 May
Three Norfolk @NHSNWCCG practices have used Total Online Triage since 2019. All patient requests for clinical help are entered into the online system, either by patient or receptionist.
Total online triage is good for analysis of demand, since all demand is captured. No patient is told 'no appointments left, try again tomorrow'.

Many of the lessons will apply to practices using online consultations in other ways.
Read 26 tweets
11 May
Why that @prof_tweet modelling paper does NOT show that online triage increases GP workload, and what we can learn from it. THREAD⬇️
@MinalBakhai @HelenRSalisbury @padsbigsis @mgtmccartney @keithgrimes @MartinRCGP @murrayellender @fhussain73 @bcdelaney1 @BenXGowland @ClareGerada
I preface this by saying @prof_tweet is great and his 2018 Mackenzie lecture profoundly influenced my thoughts on general practice.
As the paper acknowledges, the benefits/costs of online triage depend strongly on the assumptions fed into the model.

There is one HUGE assumption that, on its own, makes the difference between huge efficiency and huge inefficiency.
Read 19 tweets
1 Apr
Lots of debate recently about triage in GP. Here's a thread with a detailed argument:

@MinalBakhai @SteveLaitner @dave_dlt @dr_musgrave @sib313 @stevekellGP @HelenRSalisbury @H_Atherton @jacobnhaddad @SiliconPractice
The short version:
- there's no such thing as no-triage General Practice
- it's reasonable to argue that traditional model beats current model, for some practices, but:
- tech improvements will make a triage model far superior to traditional model.
Let's not get too hung up on the semantics of 'triage', please. I use it as a shorthand for 'getting a problem dealt with in the most appropriate way, by the most appropriate person, in the right timeframe'.
Read 25 tweets
1 Apr
(section 2 of mega-thread)
Part 4. There is no good evidence that patients want everything to be done face-to-face. In fact there is strong evidence to the contrary. Obviously, will vary between patients and according to the nature of the problem.

It's OK to defend the 8am telephone scramble, the 4 weeks waits, and forcing patients to take half a day off work for a straightforward problem. But be in no doubt that this does no favours for some of our most vulnerable patients.
5. It's commonly argued that GPs must keep seeing everyone F2F to allow for those 'and another thing' moments. This argument needs much more scrutiny.
Read 17 tweets
31 Dec 20
GPs about to hit a perfect storm:
⬆️Covid-induced demand
⬆️demand from 2ry care delays
💉nurse/HCA clinic time lost to vaccinations

GPs urgently need specific guidance empowering us to suspend a large proportion of routine work.

THREAD to explain why this is needed ⬇️
@FSRH_UK has probably been the best at giving pragmatic guidance for GPs, e.g.
- leave in a contraceptive implant for a 4th year
- leave in a mirena for a 6th year
- reduced requirement for BP monitoring for contraceptive pill

But in most clinical areas such guidance is lacking.
@rcgp's Workload prioritisation advice is of some use but:
- outdated (e.g. advice to delay smears is not in keeping with @NHSEngland advice)
- lacking detail

Read 7 tweets

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