AQW 10560/17-22


Mr John Blair
Alliance Party
South Antrim


Tabled Date: 18/11/2020
Answered On Date: 01/06/2021
Priority Written: No


Question:
To ask the Minister of Health for his assessment of the current arrangements for GP appointments and the impact this is having on emergency departments.


Answer:
General Practice, as with all other areas within the health and social care system, has had to react quickly and adapt flexibly to the demands and challenges of the pandemic. Despite the demands and capacity limits that COVID has created, GPs have maintained all of the core elements of general practice services. 
It is important to stress that GP practices are open and are providing face to face appointments for those patients who are assessed as requiring them.
Recently collected figures indicate that in that particular week there were 164,137 GP and Practice Nurse consultations. That is a rate of 82 per 1,000 patients. Almost 40% of these were face to face. For comparison, information collected in November 2019 shows a consultation rate of 86.8 per 1,000, of which 50% were face to face. The 2019 face to face activity would have included activities such as screening, which are now gradually being reintroduced.
The response to the COVID-19 pandemic has meant the introduction of innovative ways of working.
GP practices are operating a telephone first triage system which allows patients to continue to seek medical advice from their GP for both routine and urgent problems. The GP then uses their clinical judgement to decide on the most appropriate approach to the patient’s care and treatment, including if the patient can be safely managed over the telephone, signposted or directed to other appropriate services, or whether a face to face appointment is required. Technologies such as video conferencing and enabling patients to send photographs by text have helped to facilitate diagnosis and ensure that patients are only required to visit surgeries where it is absolutely essential. 
I recognise that face to face appointments are valued by many people as the norm for GP delivered care and that patients have at times found it difficult to access GP services via telephone. However, the model of primary care in place prior to the pandemic was already under considerable pressure and was not sustainable without significant change.
The scale of demand for GP led services has continuously grown over recent years. Figures collected in November 2019 indicate that there were almost 15 million total contacts with general practice per year. For comparison, in 2014, the estimated total number of contacts was 12.7 million.
The need for transformation in primary care was already clear and initiatives such as the Multi-Disciplinary Team Programme, investment in technology, including telephony, the introduction of Advanced Nurse Practitioners and additional General Practice Nurses were already making a difference to how services are delivered in primary care.
The use of more innovative ways of working, including telephone triage and telephone and video consultations, is now widely embedded within the primary care sector.  As we emerge from COVID, it will be necessary to complement traditional ways of working by building upon new approaches, including the use of digital innovation and skills mix, to help ensure the sustainability of GP services in the face of increasing pressures and demands.
Building on the COVID-19 Centre model of collaborative support, new arrangements are being developed to better support and co-ordinate unscheduled care.
GPs are playing a key role in development and implementation of the new models of care and pathways required to deliver the 10 Key Actions in the COVID-19 Urgent & Emergency Care Action Plan ‘No More Silos’.  
We are already starting to see the benefits of this work through the first Urgent Care Centres which are able to direct a number of patients planning to attend an Emergency Department to other more appropriate services. The ‘Phone First’ service that is also being introduced enables patients who have an injury or illness that requires urgent treatment to be assessed over the phone by a health professional who will then be able to book an appointment with the appropriate service.
We are seeing new approaches to scheduling unscheduled care, and we are developing new direct access pathways into the services that patients need.
These new models of care will ensure that patients can access assessment, advice and information whenever they need it, and that they receive their care in the most appropriate setting.