Urban GPs with large patient lists are among those most likely to give patients phone consultations, The Ferret has found, raising concerns about the postcode lottery on appointments facing Scottish patients.
More than three quarters of GP practices were still seeing less than half of their patients face-to-face last May, according to our investigation.
We also found patients registered at urban practices are more likely to be offered virtual appointments with their GPs than those registered to rural practices — even though travelling to face-to-face appointments could be more difficult.
Our analysis also found GPs with the largest patient lists were most likely to have phone consultations with their patients. Doctors with the largest lists – over 4,000 – held 66 percent of consultations by phone last May. There were 16 of these practices, with 83,553 people registered between them.
Meanwhile those with the smaller number of patients registered – less than 500 per GP – held only 39 percent of appointments by phone. Fifty practices in Scotland have GPs with patients lists of this size.
Commenting on the findings, advocates and opposition politicians raised concerns about the postcode lottery facing Scots and called for all patients to be allowed to “access the care they need’.
GPs in short supply
Patients who spoke to The Ferret said they struggled to get face-to-face appointments even when they requested them, forcing them into accepting phone consultations.
Earlier this year the British Medical Association warned Scotland has a chronic shortage of doctors, with about 2,000 more required across the country.
Some doctors claimed surveys showed patients wanted the option of phone appointments, which were a convenient way for people to access healthcare without taking time off work.
But other GPs said phone appointments meant things could be missed more easily than at face-to-face consultations.
Figures from Public Health Scotland show that by December last year two thirds of appointments across Scotland were face-to-face.
In 2019 only about ten percent of appointments were held remotely. The figure soared to over half during the pandemic.
But analysis by The Ferret of Scotland’s latest health and care experience survey data found patients faced a postcode lottery situation.
It showed large practices where GPs have 4,000 or more patients registered, held only a quarter of appointments in person last summer.
But at smaller GP surgeries, where doctors had 500 patients or less on their books, the rate of face-to-face appointments was more than double – 60 percent of consultations were held in person during the same time period.
Urban and rural split
Those with the highest level of face-to-face appointments were usually in rural island locations.
Doctors in the Western Isles, Shetland, Orkney and Highland health board areas saw the most patients at their surgeries – all well over half. Greater Glasgow and Clyde and Lanarkshire GPs held the least amount of appointments in person.
In total 44 GP practices held more than three quarters of their consultations by phone last May. Almost half of those were Greater Glasgow and Clyde health board practices and almost a third in Lanarkshire.
Meanwhile, 24 GP practices held more than three quarters of all consultations face-to-face – almost half in the NHS Highland area.
Alex from Glasgow, said she had to fight for a face-to-face appointment for her nine-year-old son, and claimed telephone appointments had failed to get to the root of his health issues. She asked not to be identified to protect her son’s confidentiality.
He started to suffer from acid reflux in August last year, waking him from his sleep and leaving him tired and grumpy. It took her days to get through to the surgery on the phone and secure a phone consultation in a week’s time.
Her partner missed the call when it came in because he was at work, meaning they had to start all over again. In the end it took six weeks to get an appointment, which led to medication being prescribed.
I think phone consultations are fine as part of a GP service. But in this case if I had been offered a phone appointment in two weeks, or a face-to-face one in six weeks, that’s what I would have chosen.
Alex, patient
“It’s made things a little bit better but not dramatically so we really need to go back,” she added. “But I wonder if there’s much point, if there’s anything they will offer that will help?
“I don’t think the GP has the time to talk to us about what could be at the root of the problem and when you’re flustered on a phone consultation it can be hard to remember everything you want to say.
“I think phone consultations are fine as part of a GP service. But in this case if I had been offered a phone appointment in two weeks, or a face-to-face one in six weeks, that’s what I would have chosen. Surely there’s a better way.”
Meanwhile, she is making lifestyle changes to when and what her son eats and has booked an alternative therapy session for him to assess whether his condition is stress related, but is aware the cost of this could be prohibitive to others.
Dr John Montgomey of Glasgow’s David Elder Medical Practice in Govan, said that GP surgeries were still confined by ensuring infection control measures were in place. He also claimed phone appointments could be important for people with non-serious conditions who didn’t want to take a day off work.
He said emergencies are always seen face-to-face, and added. “We polled our patients as the restrictions were starting to ease, and yes, the preference was for face-to-face consulting. But the majority wanted the option of both.”
Virtual appointments have a role to play, but they cannot be a sticking plaster for overwhelmed services struggling to cope.
Jackie Baillie, Scottish Labour
GP and Deep End chair Carey Lunan, who spoke to The Ferret for its GPs in Crisis series last month, claimed then that doing appointments remotely “feels like there is risk in that because you have less information when you can’t see someone”. She added: “You can’t pick up cues, you might be having to work with a translator and you don’t know if they have properly understood.”
Our GPs in Crisis investigation found that GPs felt they were working in an “unsafe way” due to unsustainably long hours and doctor shortages, while patients said they were at risk because they could not access their GPs.
Opposition politicians said the postcode lottery of telephone appointments found by The Ferret showed a failure from authorities to tackle the issue.
Scottish Labour health spokesperson Jackie Baillie said: “Virtual appointments have a role to play, but they cannot be a sticking plaster for overwhelmed services struggling to cope.
“This postcode lottery must end so that every patient can access the care they need. The SNP must support GPs across Scotland and recognise the vital role they play in our healthcare system.”
Scottish Liberal Democrat health spokesperson Alex Cole-Hamilton MSP added: “The Scottish Government is responsible for year after year of mismanagement, letting GP shortages worsen and patient lists climb ever-higher.
“Phone appointments can make it hugely difficult for some patients to describe their symptoms fully, making it challenging for GPs to diagnose them accurately.”
GP demand outstripping capacity
Dr Andrew Buist, chair of BMA Scotland’s GP Committee, said there was “a huge mismatch between spiralling demand and capacity of GPs to meet that demand”.
“We just don’t have enough GPs,” he added. “The latest figures show 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.
“Some patients will prefer the convenience of a phone call to fit round busy lives, but we all know there will be circumstances where that doesn’t work either for the GP or the patient and can indeed make diagnosis harder.”
But, he insisted “the hybrid model” of both phone and in-person consultation was “here to stay” and called for more support to be provided to help GPs cope with local challenges including recruitment.
A spokesperson for the Scottish Government added: “Patients should always be seen face to face where there is a clinical need.
“GP practices received a letter last November from the then Cabinet Secretary for Health and Social Care, Humza Yousaf, encouraging them to ensure there is an appropriate mix of pre-booked, same day, face to face and remote appointments that suits individual practice populations.”
Cover image thanks to iStock/Pornpak Khunatorn
