10 September, 2021
On the 10th of September the Times reported on concerns raised about the deaths of six patients seen remotely by GPs during the pandemic. The reported issues included suicide, a broken leg, COVID-19 and a drug overdose.
Alison Mutch, Senior Coroner for Greater Manchester highlighted five prevention of future death reports and expressed concerns over telephone appointments.
An overdose resulted when prescription drugs were prescribed for pain medication against a background of addiction, self-harm and poor prescription and illicit drug use.
A 99-year-old gentleman suffered a broken leg. The hospital did not x-ray the correct area and he was discharged. He experienced ongoing pain and was reviewed by the GP on the phone. He did not return to hospital until it was too late.
Another death was investigated where a patient contacted their GP on numerous occasions about anxiety and depression. Mutch said; "pre-Covid it was accepted that she would have been seen face-to-face, which would have allowed a more comprehensive assessment of her mental health and her reluctance to use medication."
Virtual visits costing lives is well documented in cancer diagnosis and treatment. During the pandemic NHS England advised on a 'total triage' approach where face-to-face was a last resort after video consultation to reduce the risk of infection.
Pressure on services remains an issue as many GP practices continue to vaccinate the population, but as the uptake increases so should the protection and return to normal practice.
Some people argue that video telephone consultation provides more flexibility and access to some busy people. However, those unfamiliar with technology might be reluctant or unable to use it and it raises concerns on whether the care can be of a consistent standard. Clinical signs and symptoms are a key diagnostic tool and people must be considered as individuals. Everyone must be looked at in relation to age, vulnerability, symptoms and medical history.
In May 2021, following the change in social distancing rules, NHS England ordered all GPs to offer face-to-face appointments to all patients, and move away from the 'total triage' model.
'While the expanded use of video, online and telephone consultations can be maintained where patients find benefit from them, this should be done alongside a clear offer of appointments in person.'
'Patients' input into this choice should be sought and practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary, for example the presence of Covid symptoms.'
If conducting a remote consultation, GPs must be 'confident that it will not have a negative impact on their ability to carry out the consultation effectively'.
We expect to see evidence of problems caused by the pandemic and the practices adopted but hope that a hybrid model based on the guidance will prevail, because people and their problems are unique.
For more information contact Leonie Millard in our Clinical Negligence department via email or phone on 01254 770517. Alternatively send any question through to Forbes Solicitors via our online Contact Form.