GP practices in England were told they “must all ensure they are offering face-to-face appointments” in a letter sent by NHS England and NHS Improvement (NHSE&I) medical director for primary care Dr Nikki Kanani and NHSE&I director of primary care Ed Waller last week (May 13).

They were also asked to “respect [patients’] preferences for face-to-face care unless there are good clinical reasons to the contrary, for example the presence of COVID symptoms”.

“Diktat” will increase demand

In response to the letter, the British Medical Association GP committee chair said NHSE&I should clarify how GP practices are “expected to meet demand” to offer patients their preferred choice of appointment.

In a statement published today (May 18), the Guild of Healthcare Pharmacists (GHP) has also asked NHSE&I to rethink its instructions on “insisting” that practices offer in-person appointments.

“While we recognise the need for a proportion of appointments to be face to face, we disagree with the diktat that the offer of a face-to-face appointment must be given. This will simply increase the demand on already stretched services,” the GHP said.

Impact on primary care pharmacists’ morale

The NHSE&I letter will have had an “adverse impact on the morale, mental health and wellbeing of the pharmacy team” in practices and further feeds into the “false narrative” that GP practices worked behind closed doors during the pandemic, the GHP added.

This view is echoed by Laura Buckley, a locum and pharmacist at a primary care network (PCN) in East Yorkshire.

“The release of the letter by NHSE&I is demoralising for the teams that have gone above and beyond during the pandemic and the vaccination rollout, and has served only to add excess pressure and undue stress at a time when teams are already on the edge of burnout,” she told C+D.

GP practices kept their doors open during the pandemic to see patients in person “where necessary” and it is “severely misguided” to suggest otherwise, Ms Buckley concluded.

Use of technology to meet patients’ needs

The GHP added that, during the pandemic, primary care pharmacists have adopted telephone triage and video appointments to meet their patients’ needs.

“Pharmacists are skilled healthcare professionals and can be trusted to make appropriate decisions about the best consultation mechanism for individual situations, and we would like NHSE&I to recognise this,” the GHP said.

Danny Bartlett, senior clinical pharmacist for the Coastal and South Downs Care Partnership PCN, told C+D today that “virtual and remote accessibility has its upsides, too”.

“Younger patients and working professionals can now have letters and important counselling information sent to their mobiles. This means our practice is able to be more efficient and fluid and can improve patient outcomes in those demographics that find it difficult to carve out time to visit a practice in person,” Mr Bartlett said.

He agreed with the GHP’s statement that mandating face-to-face appointments when these are preferred by patients will put “pressure an already stretched service, particularly with vaccine clinics on full steam”.

Community pharmacists: in-person appointments should be available when necessary

Amish Patel, superintendent pharmacist at Hodgson Pharmacy in Longfield, Kent told C+D today that in some cases, patients have been denied the opportunity of face-to-face appointments during the pandemic.

“This is not acceptable and general practice needs to be more open to face-to-face appointments when necessary, following an appropriate triage,” Mr Patel added.

Amanda Smith, manager at Heath Pharmacy in Halifax, West Yorkshire, told C+D that “if a patient feels strongly that they need a face-to-face appointment then they should be able to have one unless there are clinical reasons not to”. She added that her pharmacy team sometimes hears of patients complaining about virtual appointment options.

However, she recognises that the NHSE&I advice could add pressure on the already stretched GP services.

“It’s an ideal opportunity for surgeries to make use of the new GP Community Pharmacist Consultation Service and refer patients with appropriate conditions to their community pharmacy. We can assess them, give advice, and refer onwards if necessary, helping to free up appointment slots for more serious conditions,” Ms Smith added.