Are GPs avoiding face-to-face appointments? Eighty per cent of all appointments in England were face-to-face pre-pandemic but just 58 per cent today – probably lower in Scotland.

Sajid Javid has proposed a "rescue" package of £250million for English GPs to increase face-to-face consultation with a naming and shaming list ready for those who fail to comply. But doctors’ organisations warn of a mass exodus by exhausted, demoralised GPs if Javid demonises their profession against a backdrop of acute GP shortages – around 900 short in Scotland and more than 9,000 short in England.

Certainly, if the family doctor’s job becomes less attractive, exacerbated by security fears after the murder of Sir David Amess, medical students will continue to steer away from GP practice.

Certainly too, demand for appointments is continuing to soar. One Ayrshire practice is getting 500 daily calls compared to a pre-pandemic average of 150 and has resorted to automatic call diversion. The number of no-shows has meanwhile halved, so there are no gaps but a lot more paperwork in the GP’s day – like providing certificates for insurance purposes.

History shows very little progress is made when a workforce feels blamed, cornered and antagonised – certainly not one as well organised as the medical profession. So Javid’s threatening move appears to be a tactical mistake the Scottish and Welsh governments have disowned.

But Javid’s basic question does remain. Are some GPs failing to see patients face-to-face when it’s necessary?

I’ve had an auto-immune condition that’s required a monthly blood test for the last eight years – cheerfully and professionally delivered by two Fife practices through thick, thin and Covid. Emails answered on Saturday and Sunday tell me there’s no slack in the system for my current, excellent GP. But other people are having a very different experience.

The wife of one friend couldn’t get a telephone, zoom or face-to-face appointment at a practice whose phone seemed permanently switched to voicemail. She was eventually taken to A&E, diagnosed with pneumonia and admitted to hospital. Another friend with a persistent cough – not Covid – had to settle for a phone consultation after which he was given two courses of antibiotics. A month later, in hospital, he was diagnosed with cancer.

Their practices (neither in Fife) are locally regarded as harder to enter than Fort Knox, but since neighbouring practices have closed their lists, patients dare not antagonise doctors they cannot escape and so there are few formal complaints.

Are such situations rare or common? There’s no way of knowing and very few ways to make immediate improvements since GPs are the only health professionals who are independent contractors and cannot easily be instructed, reassigned or redeployed by local NHS boards. That massively complicates the current GP appointment rammy.

When hospitals get instructions, they must simply apply them. But GPs make their own decisions about many things from staffing levels to the way they decide which patients need face-to-face attention. Some GPs filter appointment requests through receptionists, some use non-GP health staff, others have GPs on phone-calls or zoom/skype or a combination of all three. But there’s no industry standard.

This highly variable picture is further complicated by the growth in part-time GPs. Some part-timers are new parents or managing the stress of the job, but some are working part-time in their own practice and then part-time as locums (temporary doctors) in other practices, charging "extortionate amounts" to the NHS.

Whatever the reason, GPs are hard to fit into wider NHS workforce planning. Other health professionals can be more easily relocated to fill healthcare gaps caused by rurality, poverty or population growth. GPs – less so. And of course, any attempt to move surgeries or change catchment areas and redistribute patients would be unpopular.

So, part of the solution is the primary care hub in which salaried NHS GPs work beside a range of health professionals to help patients with obesity, mental health issues, diabetes etc and refer them on to third sector specialists like SAMH, self-help groups and other members of the Health and Social Care Alliance. Hubs – with more space for students and new doctors – are being pushed on both sides of the border but Holyrood’s decision to merge health and social care budgets in 2014 has given Scotland a head start.

Some GPs are also pushing traditional boundaries. The Deep End GP group is a network of surgeries covering Scotland’s hundred most socio-economically deprived populations, which has piloted the pioneering Community Links Worker Programme connecting local community organisations with doctors and some patients.

Essentially the GP shortage cannot be plugged overnight, so Health and Social Care Partnerships are working round it, hiring more NHS GPs and allied professionals to share the load – like advanced nurse practitioners who deliver flu jags, smear tests, take blood tests and blood pressure readings.

It’s not a perfect or speedy solution. Only 55 GP practices are salaried – six per cent of the total. There’s public resistance to "centralised" healthcare where there may be no named GP. But this – along with tele-medicine – may be the face of the future.

The classic doctors’ waiting room is actually the last place anyone should want to be – full of sick people, especially during flu season. But for most patients to accept phone or zoom as the new normal, a lot of things must change.

Failing practices, generally well-known to councillors and MSPs, must be tackled. That means Scotland needs a regulator like the Care Quality Commission because Healthcare Improvement Scotland lacks the power to investigate these wide variations in GP services.

Patients must believe phone and video appointments are the result of good triage and individual assessments – not auto-pilot. After all, many folk on low incomes have no internet and only half of the over 80s have a smart phone. So, the slogan must be digital too – not digital first.

More investment, flexibility and trust is needed before face-to-face appointments move online and the next generation of GPs ditches the old, independent-contractor model to become part of NHS-run primary care teams.

Can GPs stomach such wholesale change? The bigger question – can we?