Matt Hancock, the Health Secretary in England, has made a speech to the Royal College of Physicians in London, entitled “The Future of Healthcare”, in which he has called for an end to routine face-to-face appointments with GPs. He also said that even in some emergencies, people should try to go online before turning up at “A & E” (sic). He is hailing a new era of “Zoom Medicine”. He says we don’t need to attend our GP surgery “unless there is a compelling clinical reason”. He also said that following the pandemic the NHS “must not fall back into bad old habits”.
Response from the medical profession has been typically low key. Professor Martin Marshall, Chair of Council, Royal College of General Practice, has acknowledged that the Covid pandemic has altered the way GPs practise. Previously, 75% of GP consultations were face to face. During the height of lockdown, it fell to 15%, and has now risen to about 30%. Prof Marshall thinks it might settle down at about 50:50. He is not comfortable with the “remote by default” position. It doesn’t feel very patient-centred to him. He also points out that remote medicine will not be an attractive career option for junior doctors.
For the doctors’ union, The British Medical Association, Dr Richard Vautrey has said, “If doctors are given access to the right technology, they will embrace it. However, (Matt Hancock’s) suggestion that all appointments going forward will be remote by default must be approached with caution.”
All very nuanced.
The subject was raised on BBC Radio 4’s Any Questions. The responses from the panel were predictable: an acknowledgement that the ability to consult remotely has been a boon during the pandemic when we have had few other options, tempered by an appreciation that a face-to-face consultation must inevitably be a better means of communication for both patient and doctor. The issue came up again on Any Answers, and Dr Carey Lunan phoned in to draw attention to the many disadvantages of remote consulting, as well as to question the assumption that consulting by video saves time. I think it would have been helpful if she had stated that she is Chair of RCGP Scotland. She drew particular attention to the many groups of vulnerable patients who would struggle to cope with remote technology, as well as to the advantages of face-to-face consultation.
It strikes me that there is something very odd about Mr Hancock (PPE, Oxford, MPhil, economics, Cambridge) telling a bunch of physicians, (MB ChB, FRCP etc) how to practise their craft. Well, not really their craft, because Mr Hancock is primarily talking about the delivery of primary care. Physicians in internal medicine by and large don’t see patients who haven’t already been seen by a GP or an emergency physician. They might have said to Mr Hancock, with some justification, “Well, we are actually doing what you ask already. Our colleagues in primary care communicate with us; we vet the referrals and issue advice or arrange to see the patient if required.” So why didn’t Mr Hancock address the Royal College of General Practitioners rather than the Royal College of Physicians? Did he have a sense that the audience he chose would give him an easier ride?
But is it not passing strange that an economist should tell a doctor how to do his job? Imagine the Minister of Transport addressing BALPA, the pilot’s union, and saying, “From now on, you’re grounded. With drone technology, you can fly the A380 to New Zealand, and back, and never leave Surrey. No jet lag. Much more efficient.”
But to return to the Health Minister, given that he addressed his remarks to the wrong college, we may suppose his approach has not been very collegiate. It doesn’t appear as if he has consulted extensively with the medical profession to come up with his Zoom plan. This sounds much more like a directive from on high.
The medical profession must be much more robust in telling Mr Hancock not to dictate how medicine is to be practised. The idea that a Zoom consultation should be superior to a face-to-face encounter is preposterous, chiefly because remote physical examination is impossible. Once again, the sanctity of the medical consultation is coming under attack. We must put this attack in historical context. In 2005 when GPs handed out-of-hours care over to health boards, they gave up power as well as responsibility. As a result, a third party entered the consulting room, the poltergeist within the computer screen – the Quality Outcomes Framework (QOF) – dictating how GPs should work. Now that Mr Hancock wants to digitise primary care, the big tech companies are itching to manage our data. Zoom Medicine will be the QOF on steroids.
Medicine is fundamentally a “hands on” profession. No medical students will contemplate a career in general practice because they will not wish to spend all day staring at a computer screen. If no GPs are trained, general practice will collapse. If general practice collapses, the public hospitals will come under enormous pressure and they, too, will collapse. The only winners will be the patients who can afford to consult their physician in the private sector, who in turn will be delighted to see them, in person.
Fortunately, here, north of the border, health is devolved. We don’t need to go down Mr Hancock’s dreadful path.