Warning new patient screening rules for GPs will 'severely limit' access to face to face appointments

Voting on the measures during their annual conference, GPs called on the Scottish Government to communicate the changes clearly to the public amid fears that medics and practice staff will face a backlash from patients.

“We are very worried that this just makes a very difficult situation worse,” said Dr Andrew Buist, chair of the BMA’s Scottish GP committee.

READ MORE: GPs report rise in hostility from patients over in-person appointments

Under the guidance - issued on November 25 - every patient assessed as requiring a face-to-face GP appointment regardless of their ailment will be asked nine questions by reception staff so that they can be allocated into either a respiratory or non-respiratory pathway.

Dr Buist said: “That’s every single patient, whether they’ve got a mole they want looked at or backache or they need their angina treatment reviewed.

“Patients already complain that they can’t get through on the phone and the reason for that is the receptionist speaking to someone else.

“If each call where it’s decided that you need to be seen face-to-face involves answering nine questions, that’s going to add at least two minutes to every phonecall.

"If it’s not done there then it needs to be done at the front door, which means a member of staff with a clipboard asking these nine questions before people get into the building.”

Dr Andrew Buist

Questions include whether patients have visited a 'red list' country, if anyone they live with is waiting for a Covid test result, and about possible Covid symptoms, but even having a negative Covid PCR test on the day would not be enough to rule out the virus.

Once inside the practice, respiratory and non-respiratory patients are supposed to be kept apart in separate waiting areas and consultation rooms.

The guidance states that the protocol will “minimise the risk of harm from respiratory viruses including, but not exclusively, Covid-19, influenza and Respiratory Syncytial Virus (RSV)” to staff and patients during the winter months, but GPs warn that in many small and older premises it will be impractical and potentially dangerous to implement.

Previously any patients with key Covid symptoms, such a persistent cough or loss of sense of smell, were diverted to Covid Assessment Centres (CACs) in the community but these are being wound down or have already closed in areas including Fife and Orkney.

READ MORE: Face to face appointments should be 'rationed' for good to manage demand, says medic

The BMA is calling on the Scottish Government to instruct health boards to maintain or reinstate them to reduce the risk of patients who are sick or immunosuppressed mingling with Covid patients in general practice.

Across Scotland, around 250,000 GP appointments per week are being carried out face-to-face but the profession is concerned that the time taken to quiz patients over the phone coupled with an increase in patients coming to general practice who were previously seen in CACs will “slow down” access to appointments for non-Covid patients.

“If the experts say that is something we have to do in terms of infection control, then we have to do it, but the public need to be told about it and this needs to come from the very top,” said Dr Buist.

“This needs to come from [Humza] Yousaf or Nicola Sturgeon. They need to explain to the public what is happening and why it’s being done and the impact this will have on their ability to get an appointment, because it’s undoubtedly going to reduce.”

Dr Emily Andrews, of the Forth Valley Local Medical Committee (LMC) told the conference that the policy would “severely limit how many patients can be seen on a face to face basis, thus potentially affecting and putting at risk those with chronic diseases and complex care needs”.

She added: “Many practices do not have the infrastructure to dedicate a specific room and waiting area to more respiratory patients, not the capacity to carry out a thorough clean afterwards without considerable cost and use of resources.

"To propose that practices could see all respiratory patients at the end of the day instead is unrealistic.

Some practices run as a single-handed GP or there is a large practice population and their respiratory patient numbers would be considerable."

The conference heard that a recent audit of GP practices in Grampian found that 70% had "no safe space in their premises to see patients in the respiratory pathway" if they implemented the guidance.

READ MORE: Scotland's NHS recovery plan will fail without serious investment in staffing

There were also warnings that the questions used to screen patients are "too broad" and will lead to patients with runny noses, sore throats, tiredness and muscle aches being allocated to the respiratory pathway, potentially "overwhelming" that side of the service and leaving patients waiting even longer than before to see a doctor.

Dr Iain Morrison, chair of the LMC, said: "There's been no consideration at all to the larger public health issue of restricting access.

"For the protection of the public from non-Covid viral illness they will have their general medical services delayed - is this benefit really worth the risk?"

Dr Morrison added that the policy would have "dire consequences" for GP workload and trigger an "inevitable backlash" from the public.

One GP told the conference her practice had had to call the police twice in the past six months to have aggressive patients removed, while others described "constant abuse"as a result of claims GPs are refusing to see patients in person.

The total number of consultations being carried out in Scotland is higher than before the pandemic as a result of telephone and video appointments.

More than half of all consultations still being done face-to-face, but prioritised by clinical need.

Dr John Ip

Dr Andrew Cowie, deputy chair of the SGPC, said the guidance will "trap GPs between legal censure for not following protocols and public fury at a reduction in service", while John Ip, of Glasgow LMC said GPs will be "blamed and scapegoated" for the changes.

He said: "GPs on the frontline have a tough enough job at the moment - the abuse and negativity they currently get is not acceptable. These screening questions at the front door will only make things worse."

A Scottish Government spokeswoman said it welcomed feedback from GPs.

She said: “Our national guidance reflects clinical advice about infection and what prevention and control measures we should be considering to help keep our staff working safely.

"We recognise that implementing this guidance may be challenging for some GP practices and we have written to Health Boards to ensure adequate support systems are in place locally. We will also explore what flexibility can safely be accommodated.

“This winter is expected to be challenging for the whole service, as we manage the inevitable increase in respiratory illness, Covid and the impact of the new variant.

We will continue to work closely with the Scottish General Practitioners Committee to seek feedback from local areas.

“We continue to support practices with necessary PPE and in addition to the £30 million sustainability payments, we have also recently announced an £5m of funding to support premises adaptation."