Fewer than one in three GP appointments are face-to-face with a doctor, a study has revealed.
Analysis of NHS general practice data from between August 2022 and March 2023 found that 29.6 per cent of all appointments delivered by GP surgeries were in person with a family doctor.
Almost 40 per cent were face-to-face with another healthcare professional but not a doctor, such as a physician associate, nurse, or paramedic. The rest were delivered remotely over the telephone by either a doctor or another healthcare worker.
The study, published in the British Journal of General Practice, found patient satisfaction was lower at surgeries that relied more on both telephone appointments and consultations with staff who are not GPs.
The research revealed GP practices that offered more same-day appointments also had less satisfied patients.
Researchers from the University of Manchester looked at 5,278 practices, their appointments, and the results of the NHS general practice patient survey. The results showed a “higher volume of appointments, especially face-to-face with GPs, was significantly associated with increased patient satisfaction.”
The team concluded that there was a positive link between face-to-face appointments with a GP and patient satisfaction and the ability to have health needs met.
They said patients’ experience of “GP access” was not just about immediate, same-day slots, but a wider ability to get in and see a doctor in person.
“Initiatives to improve access to and satisfaction with general practice should prioritise expanding face-to-face GP appointments,” the authors wrote.
The researchers suggested patient satisfaction could increase by 1 per cent for each additional 10 face-to-face GP appointments per 1,000 patients per month.
Non-GP clinicians ‘undoubtedly important’
In their study, 69.5 per cent of all appointments were face-to-face and 27.2 per cent were on the phone. Some 29.6 per cent of appointments were face-to-face with a GP and 18.4 per cent were GP telephone appointments, meaning fewer than half of all appointments involved a doctor.
The study detailed how those practices with a larger amount of telephone consultations had less satisfied patients than those who held more face-to-face. This decreased only slightly when phone calls were carried out by GPs, rather than non-GP staff.
Dr Patrick Burch, an academic clinical lecturer at the University of Manchester and a practising GP, said: “While telephone and IT-assisted appointments have an important role to play in general practice, we would cautiously welcome an overall increase in the proportion of face-to-face consultations.
“Until recently, simply employing more GPs was not seen as feasible. However, given six out of 10 job-seeking GPs have struggled to find a vacancy to apply for over the past year, this may now be a potential option.
“We would also welcome measures that free up GP time to enable more patient appointments.”
Dr Burch said non-GP roles in primary care since 2019 have increased by 21,600 full-time equivalent staff members.
He said cash was being used to pay less expensive clinicians rather than GPs, but said there is “undoubtedly an important role for non-GP clinicians in primary care”.
The work comes just over two weeks after an expert from the University of Oxford said allowing physician associates to take on the responsibilities of NHS doctors costs lives.
‘Years of underinvestment’
Professor Trisha Greenhalgh said not a single study has looked at whether PAs or anaesthetic associates (AAs) in the NHS are safe.
The health service has a plan to increase the number of PAs and AAs from around 3,500 at present.
Professor Kamila Hawthorne, chair of the Royal College of GPs, said: “We know that many patients prefer to see their GP face to face. We also know that many patients prefer the convenience that remote consultations offer.”
She said that amid growing demand for services, “we simply don’t have enough GPs to keep up”, and also said non-doctor roles “should not be used to plug gaps in the workforce that have been created by years of underinvestment”.
The Department of Health and NHS England were asked for comment.