A medical negligence expert has shed light on the rights UK residents have when it comes to seeing a GP, in response to the GP Patient Survey by NHS England which shed light on the challenges faced by patients seeking face-to-face appointments.
The survey’s findings revealed that one in three (34.7 per cent) participants struggled to contact their GP via phone, with over a quarter (27.7 per cent) having remote GP appointments. Alarmingly, 42.5 per cent rarely or never see their preferred healthcare professional upon request.
Sophie McGarry, a solicitor at Patient Claim Line, has clarified your legal entitlement to an in-person GP appointment and advised on steps to take if you believe you’ve been misdiagnosed during a remote consultation.
Your legal rights to in-person appointments
Patients are now legally entitled to face-to-face GP appointments if they prefer, as per recent NHS guidance. McGarry explained: “According to new NHS guidance, practices in England must offer face-to-face appointments if requested. GPs who fail to make the necessary arrangements for patients to make an appointment without having to spend hours on the phone or who are not available for face-to-face appointments are, in the strictest terms, breaking the law.”
NHS England has issued guidelines to GP practices, stipulating that they must offer face-to-face appointments. Practices should respect patient preferences for in-person care unless there are valid clinical reasons not to, such as the patient exhibiting COVID symptoms, reports the Mirror.
According to NHS England’s guidelines, if you request a face-to-face appointment, your GP practice should provide one. However, there is no strict legal entitlement to an in-person consultation if the GP deems a remote consultation appropriate.
Nevertheless, you do have the right to see a healthcare professional within 48 hours if necessary. If you feel you require a face-to-face appointment, don’t hesitate to request it and explain why. If your request is denied, you can escalate the matter to the practice manager or lodge a formal complaint.
What should you do if you’re not offered an in-person appointment?
In a letter dated 13 May 2021, NHS England advised GP Practices to ensure clear advice is available on all practice websites about:How to contact the GP and request assistance.
How to access face-to-face or walk-in services
Ms McGarry suggests initially checking your practice’s website for information on how to access face-to-face or walk-in services. If you can’t find this information on the website, you could ask the practice to provide it to you.
She also suggests that if you face any pushback from the practice, you could point them to NHS England’s letter, which mandates that this information should be at least available on its website. Request your GP Practice to schedule a face-to-face appointment for an assessment, examination, or testing and articulate why you believe an in-person appointment is necessary.
Clarify that your preference is for a face-to-face appointment, and you can cite the NHS England guidance that all GP Practices must ensure they are providing face-to-face appointments, and practices should respect preferences for in-person care.
She further stated: “If the GPs or receptionists continue to refuse to examine you in person, you could escalate the matter to the Practice Manager and ask them to explain why your wish and request for a face-to-face examination are being refused.” You can explore what options are currently open to NHS patients in the NHS Choice Framework.
How to book, change or cancel an appointment
If you believe you require an appointment at your GP surgery, you can get in touch with them using a form on your GP surgery’s website, over the phone, or in-person.
Before confirming an appointment, your GP surgery may inquire about your needs. This will assist them in determining how urgently you need to be seen and help them select the most appropriate doctor, nurse or health professional to assist you.
Are face-to-face appointments ‘better’?
Ms McGarry emphasises the importance of face-to-face consultations, saying: “Telephone and remote assessments have their place for certain minor issues, but overall, I believe in-person appointments are safer, and you are less likely to be misdiagnosed than if you had a remote assessment. If a GP is assessing someone by telephone, there is no opportunity for them to conduct any tests or examinations. If a GP is assessing someone in person, even if they just want to perform the examinations as a precautionary measure, this is more likely to identify an abnormality than a telephone appointment.”
She added: “An in-person appointment also lends itself to any incidental findings which would not be spotted during a telephone assessment. During a remote assessment, a GP is completely reliant on asking the right questions and the patient providing the right answers.”
McGarry also stressed the importance of providing a secure space for patients to discuss sensitive topics. She said: “People are also discussing difficult and sensitive personal issues. It may be easier for them to open up to a GP in an in-person appointment, where they are receiving face-to-face, hands-on, human care, which is much more personable, rather than speaking to a voice asking questions on the phone.”
She added: “Remote appointments can leave patients feeling like there is a disconnect between them and their GP, and like there is less ‘care’. In stressful and emotional situations, patients will find comfort in the GP’s physical presence and human touch. During an in-person appointment, patients are in the room with their GP, solely focusing on the consultation and discussing their symptoms. Telephone GP appointments can catch patients whilst they are at work, driving, or doing the shopping, so the patient may not be able to give the appointment their full, undivided attention.”
What are the potential drawbacks of remote evaluations?
As highlighted by NHS England, without proper training, support, and procedural development, staff may find it challenging to deliver optimal patient care through remote methods. Under these conditions, remote consultations could lead to:
- Postponed or overlooked diagnose
- Excessive or insufficient patient investigations.
- Heightened pressure on clinicians to make remote clinical judgements
- Deterioration in the therapeutic bond between patients and healthcare professionals
- A rise in the transactional nature of care rather than personalised treatment, where patients encounter limited remote interactions or feel unable to see their doctor in person.
- Lost chances to detect subtle indicators during face-to-face consultations.
- Digital exclusion of particular patient demographics.
- Growing complexity for reception teams when scheduling patients for various consultation formats.
- Technology barriers or simple obstacles, such as poor mobile reception, can create difficulties for patients required to consult remotely.
Patients who are more difficult to assess remotely
The solicitor explained: “Generally speaking, children, the elderly and those with mental health issues or communication difficulties, can be more difficult to assess remotely. Children can have difficulties expressing themselves and their symptoms so this may require more careful assessment.”
She added: “The elderly may be hard of hearing and struggle to hear on the phone, and therefore may be less likely or able to give a full account of their symptoms. They may also be less technologically skilled and be unable to share photographs to evidence issues. I believe older people value the face-to-face and human touch more. GPs may be more likely to find incidental findings, conditions and symptoms in older people during an in-person appointment.”
She also stressed the difficulty some have in expressing themselves over the phone: “Some people do not feel comfortable speaking on the phone and may find it difficult to express themselves or may benefit from an in-person appointment to feel able to open up about their mental health symptoms. However, it’s important to remember that every demographic is vulnerable to health issues, which can be difficult to assess remotely.”
Your patient rights
When a GP needs to refer you for a physical or mental health condition, you typically have the legal right to choose which hospital or service you’d prefer to attend in most circumstances. This includes many private hospitals that provide NHS services, provided it doesn’t cost the health service more than a standard NHS hospital referral.
You also have the option to select a clinical team led by a consultant or named healthcare professional, provided they offer the treatment you need. Learn more about selecting a hospital or consultant and choosing a mental health service.
Appointments can be booked through the NHS e-Referral service. This can be done at your GP surgery or online, using the shortlist of hospitals or services provided in your appointment request letter.
Your GP selects this shortlist, so ensure you communicate your preferences during your appointment. You are legally entitled to request a change of provider if you’re likely to exceed the maximum waiting time specified for your treatment.
The hospital or integrated care board (ICB) is obliged to investigate and present you with a range of suitable alternative hospitals or clinics that could see you sooner. For more information, refer to the guide on waiting times.
Is it harder to diagnose conditions during remote appointments?
According to Ms McGarry, any condition requiring visual assessment or physical touch becomes more challenging to assess and diagnose accurately during a remote appointment. This includes infections, chest pain, and abdominal pain.
It’s crucial for patients to show the GP precisely where the pain is located and for the GP to palpate the area to determine the exact source of the pain.
Assessment of a lump or changes to the skin
The solicitor emphasised the importance of physically examining and feeling a lump to determine its location, size, texture, and whether it causes pain upon touch. It’s crucial, they noted, to compare the affected area with the unaffected side for any discrepancies.
All advice for early cancer detection is centred on being familiar with your own body, monitoring it closely, and being alert to any changes – rather than relying on photographs. GPs must physically examine a lump to decide if it appears suspicious and warrants further tests or a referral, and how urgently this should be done, whether through routine channels or an expedited two-week suspected cancer pathway.
Ms McGarry explained: “An example is a digital rectal examination to assist in diagnosing prostate cancer, or vaginal examinations with a speculum to visualise cervical abnormalities, assisting in the diagnosis of cervical cancer. GPs need to see and feel the prostate or cervix to decipher whether or not there are suspicious features which require further investigation / onward referral. They need to consider on what basis the referral should be made, either routine or an urgent two week suspected cancer pathway.”
NHS England advises: “It is not advisable to encourage patients to send clinical images of intimate regions or reveal or self-examine intimate areas during a remote consultation. The GMC is clear that all patients should be offered a chaperone. Patients who require an intimate examination should, therefore, be encouraged to attend for a face-to-face assessment.”
Limb ischaemia, which refers to a reduced blood supply to the limbs affecting potentially the arms or legs, necessitates the assessment of peripheral pulses to determine if they are weak or absent. Other conditions requiring intimate examination can include:
- Any condition requiring the assessment of temperature or blood pressure
- Visual assessment of eyes, ears or mouth
- Assessment of any orifice or skin abnormalities
If you feel you’ve been misdiagnosed over the phone or in a video consultation, what should you do?
Ms McGarry suggests: “If you believe that you have been misdiagnosed over the telephone or in a video consultation at the time of your assessment, you can ask your GP to arrange an in-person appointment for further assessment, examination or testing and explain why you feel a face-to-face appointment is necessary.”
She continued: “If that particular GP will not arrange an in-person appointment with you, you can call the surgery to make a further appointment and request an in-person appointment for a second opinion and further assessment, examination or testing and explain why you feel a face-to-face appointment is necessary.
McGarry added: “For example, you could advise that you are very concerned that the lump you have located is suspicious and you feel a physical appointment is necessary so that the GP can see and feel a lump to decipher whether or not it is suspicious and requires further investigation / onward referral and on what basis that referral should be made. If the GPs continue to refuse to examine you in person, you could ask for the matter to be escalated to the Practice Manager.”
Should your condition become urgent or worsen following a telephone or video consultation, you should take appropriate action by attending a walk-in centre, urgent care centre or A&E, depending on how severe your condition is and your level of concern.
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