AROUND two thirds of GP appointments in Scotland were being carried out face-to-face by the end of last year, according to the most detailed analysis of the trends to date.

The figures compiled by Public Health Scotland from 856 of Scotland 912 practices show that the total number of GP consultations - both in-person and virtual - has returned to pre-pandemic levels after years of disruption caused by Covid.

By 2022, an average of 1.6 million appointments were taking place each month - matching the levels seen in 2018 and 2019 - with the proportion of patients seen face-to-face gradually increasing from 60 per cent in January last year to 67% by November and 66% in December.

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However, PHS notes that technical errors mean that some some telephone consultations may have been incorrectly coded as in-person.

In the two years prior to Covid, around 83-86% of appointments were done face-to-face, but this was dramatically scaled back during the first lockdown in April 2020 when half of the 1.2m consultations carried out by GPs were done remotely, via telephone, email or online video-calls.

The Herald: Face-to-Face appointments have been on the rise and outnumbered 'virtual' appointments by a ratio of 2:1 by the end of 2022Face-to-Face appointments have been on the rise and outnumbered 'virtual' appointments by a ratio of 2:1 by the end of 2022 (Image: PHS)

Dr Andrew Buist, chair of the BMA’s Scottish GP Committee, said the PHS figures "should bring to an end any of the previous erroneous and in some cases pernicious suggestions that issues with access are to do with GPs somehow not working hard enough".

He warned that a "mismatch" between demand and capacity is "causing huge problems for practices across Scotland", however, with Scotland's GP workforce having shrunk by 3.3% in real terms since 2019 and Audit Scotland warning last week that a goal to recruit an extra 800 GPs by the end of 2027 is "not on track".

Dr Buist added: "As the system continues to adjust to post pandemic realities, two thirds of GP activity was in person as of September 2022.

"This is not as high as pre-pandemic, but reflects a return to more face to face work, balanced against the realities of attempting to meet demand through a hybrid model in the most effective way possible.”

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Dr Chris Williams, joint chair for the Royal College of GPs Scotland, said patients should have access to "an appropriate mix of appointment types and booking methods", but that "the ability to provide this is dictated by capacity within each general practice, which is stretched". 

He added: "For some patients, telephone or virtual appointments are the most appropriate and desirable form of consultation with their GP. For others, face to face remains the preferred format.

"GPs remain committed to treating their patients in the most appropriate way possible."

In England, controversial "league tables" have ranked GP practices based on access, including the percentage of appointments carried out face-to-face.

In Scotland, PHS said it is "not currently possible to reliably compare practices" because they do not record data consistently.

Dr Williams said RCGP would not support the publication of "divisive" practice-by-practice comparisons. 

"Too often, that approach fails to consider or properly represent the needs, demographics, or patient numbers of a practice," said Dr Williams. 

"Such a situation is not helpful for patients in making informed decisions about their care and may cause patients to lose confidence in their GP.

"It is crucial that a division between practices and patients not be allowed to form, as it has in England."

It comes after experts called on policymakers to "urgently invest in training for safe remote consulting" following the tragic case in England of David Nash, a 26-year-old law student who died following four telephone consultations for a painful ear infection which led to a fatal brain abscess.

The Herald: David Nash, from Cheshire, died in November 2020David Nash, from Cheshire, died in November 2020 (Image: PA)

A coroner ruled in January that he was "likely to have lived if he had been given a face-to-face appointment".

Writing in the BMJ, Dr Rebecca Rosen - a GP and senior fellow in health policy for the Nuffield Trust think tank - and Trisha Greenhalgh, a professor of primary care health sciences at Oxford University, said Mr Nash's experience should be a "rallying call to those responsible for safety in general practice".

The added: "Attending to the patient’s sense of urgency is key, but giving patients the right to demand an in-person appointment may not be the best solution to a system-wide problem.

"Updated professional guidance on remote consulting and rules of thumb for switching from remote to in-person assessments are essential next steps for safely incorporating remote care into everyday practice."

However, Dr Rosen and Prof Greenhalgh also noted that, compared to England, GPs in Scotland had much higher usage of video consultation which they said adds "valuable visual information in situations of clinical uncertainty, for example, when assessing the severity of an ill child, out of hours".

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Some patients also prefer the convenience of a remote appointment.

However, Mark O’Donnell, chief executive of Age Scotland, cautioned that while they can be a "useful alternative", there are still "huge numbers of older people in Scotland who cannot or just aren't comfortable using the internet, who may face communication barriers and find it very difficult to explain their medical concerns without examination".

He said: “For these patients, the fall in the number of available face-to-face GP appointments has proved challenging and we’ve heard from older people having difficult when securing an in-person appointment or consultation due to high demand and lengthy waiting times.

"We hope to see continued effort to ensure those who need or prefer in-person appointments can access them promptly."

Mr O'Donnell added that information on how access to face-to-face appointments vary between health boards would be useful along with some analysis of whether digital or telephone appointments "are proving more efficient".