Your legal rights explained if you aren't offered face-to-face GP appointment

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5 hours ago

Your legal rights explained if you aren't offered face-to-face GP appointment
The GP Patient Survey, released by NHS England, has highlighted the difficulties patients experience when wanting an in-person GP appointment.
What are my legal rights to an in-person GP appointment?
(Image: Getty )
A medical negligence solicitor has weighed in on common concerns Brits have about consulting their GP, shedding light on patients' rights. This comes as the GP Patient Survey , released by NHS, highlighted the difficulties patients face when seeking in-person appointments with their GP.
According to the survey, one in three participants found contacting their GP by phone to be fairly or very difficult. Over a quarter of patients had their GP appointment conducted remotely, and over two-fifths rarely get to speak to or see their preferred healthcare professional when they ask.
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Sophie McGarry, a solicitor at Patient Claim Line , has clarified patients' legal rights to in-person appointments. She has also provided guidance on what to do if you suspect you've been misdiagnosed during a phone or video GP appointment, reports the Mirror.
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Are patients legally entitled to an in-person appointment with their GP?
As of now, GP patients are entitled to be offered face-to-face appointments if that is their preference. NHS GP says: "According to new NHS guidance, practices in England must offer face-to-face appointments if requested. GPs who fail to make the necessary arrangements for patients to make an appointment without having to spend hours on the phone or who are not available for face-to-face appointments are, in the strictest terms, breaking the law."
NHS England has issued guidelines to GP practices, stating that they must ensure the availability of face-to-face appointments. Practices should respect patient preferences for in-person care unless there are valid clinical reasons not to, such as the patient exhibiting COVID symptoms.
GP practices must ensure they are offering face-to-face appointments
(Image: Getty )
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In England, NHS guidelines stipulate that GP practices should offer face-to-face appointments upon request. However, there is no strict legal entitlement to an in-person visit if the GP deems a remote consultation appropriate.
Nevertheless, patients do have the right to see a healthcare professional within 48 hours if necessary. If you feel a face-to-face appointment is required, don't hesitate to request one and explain your reasons. If your request is denied, you can escalate the matter to the practice manager or lodge a formal complaint. Find out more about the choices available to you in the NHS on its website.
NHS England says: "While the expanded use of video, online and telephone consultations can be maintained where patients find benefit from them, this should be done alongside a clear offer of appointments in person." You can read more about the choices available to you in the NHS on its website.
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What can be done if an in-person appointment isn't offered?
In a letter dated 13 May 2021, NHS England advised GP Practices to provide clear advice on their websites about how to contact the GP and request assistance, and how to access face-to-face or walk-in services. Ms McGarry suggests checking your practice's website for information on how to access face-to-face or walk-in services. If this information is not readily available on the website, you could ask the practice to provide it.
She also suggested that, should you meet with resistance from the practice, it might be useful to refer them to NHS England's directive, which mandates that such information be accessible on their website at the very least. It is important to request an in-person meeting at your GP Practice for an assessment, examination, or any tests, making clear the reasons you believe a face-to-face consultation is imperative.
You should communicate your preference for an in-person appointment, citing the NHS England guidelines that state all GP Practices must offer face-to-face appointments, and your preference for such should be honoured. Information on the options available to NHS patients can be found in the NHS Choice Framework.
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She advised: "If the GPs or receptionists continue to refuse to examine you in person, you could escalate the matter to the Practice Manager and ask them to explain why your wish and request for a face-to-face examination are being refused."
Before booking an appointment, your GP surgery may ask what you need help with
(Image: Getty )
A statement on the Gov.uk website reads: "Your practice must make every effort to meet your preferences to see the doctor, nurse or other healthcare professional you've asked for when you need an appointment, although there are some occasions when this might not be possible."
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It adds: "If you're referred for consultant-led treatment, or to a mental health professional, you can decide which provider you would like to receive care from as an outpatient and choose the clinical team who will be in charge of your care within that provider organisation."
How can you book, change or cancel an appointment?
When you feel the need for an appointment with your GP surgery, reach out to them:
using a form on your GP surgery's website (many surgeries also have a form you can access if you use the NHS App or log into your account on the NHS website)
by phone
in person, by going into the surgery and talking to the receptionist
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Your GP surgery might inquire about the nature of your health issue before arranging an appointment. This helps them determine the urgency of your situation and enables them to select the most appropriate healthcare professional for your needs.
Are in-person appointments 'better'?
Ms McGarry emphasises the importance of face-to-face consultations, saying: "Telephone and remote assessments have their place for certain minor issues, but overall, I believe in-person appointments are safer, and you are less likely to be misdiagnosed than if you had a remote assessment."
She explains the limitations of phone consultations: "If a GP is assessing someone by telephone, there is no opportunity for them to conduct any tests or examinations. If a GP is assessing someone in person, even if they just want to perform the examinations as a precautionary measure, this is more likely to identify an abnormality than a telephone appointment."
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Ms McGarry also points out the benefits of physical appointments: "An in-person appointment also lends itself to any incidental findings which would not be spotted during a telephone assessment. During a remote assessment, a GP is completely reliant on asking the right questions and the patient providing the right answers."
Clear advice should be provided and maintained on all practice websites
She adds that discussing sensitive matters can be easier in person: "People are also discussing difficult and sensitive personal issues. It may be easier for them to open up to a GP in an in-person appointment, where they are receiving face-to-face, hands-on, human care, which is much more personable, rather than speaking to a voice asking questions on the phone."
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Finally, she touches on the emotional aspect of healthcare: "Remote appointments can leave patients feeling like there is a disconnect between them and their GP, and like there is less 'care'. In stressful and emotional situations, patients will find comfort in the GP's physical presence and human touch.
"During an in-person appointment, patients are in the room with their GP, solely focusing on the consultation and discussing their symptoms. Telephone GP appointments can catch patients whilst they are at work, driving, or doing the shopping, so the patient may not be able to give the appointment their full, undivided attention."
What are the potential pitfalls of remote assessments?
NHS England has highlighted several potential pitfalls of remote assessments without proper training, support, and process development, which could lead to staff struggling to deliver optimal patient care. These issues include:
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delayed or missed diagnoses
over or under investigation of patients
increasing the burden on clinicians to make judgements remotely
reduction in the therapeutic relationship between patients and clinicians
increase in the transactional aspect of care over personalisation, where patients experience limited interactions remotely or feel they are unable to see their doctor face-to-face
missed opportunities to pick up on subtle cues during a face-to-face consultation
digital exclusion of certain patient groups
increasing complexity for reception staff when booking in patients to different consultation types
Barriers to technology or simple blockers, such as a poor phone signal, can become problematic for patients being asked to consult remotely
Are there any people who are more difficult to assess remotely?
The solicitor went on to highlight the challenges of remote medical assessments, particularly for vulnerable groups such as children, the elderly, and those with mental health issues or communication difficulties. She said: "Generally speaking, children, the elderly and those with mental health issues or communication difficulties, can be more difficult to assess remotely. Children can have difficulties expressing themselves and their symptoms so this may require more careful assessment.
"The elderly may be hard of hearing and struggle to hear on the phone, and therefore may be less likely or able to give a full account of their symptoms. They may also be less technologically skilled and be unable to share photographs to evidence issues. I believe older people value the face-to-face and human touch more. GPs may be more likely to find incidental findings, conditions and symptoms in older people during an in-person appointment.
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"Some people do not feel comfortable speaking on the phone and may find it difficult to express themselves or may benefit from an in-person appointment to feel able to open up about their mental health symptoms. However, it's important to remember that every demographic is vulnerable to health issues, which can be difficult to assess remotely."
Additionally, patients have the right to choose their preferred hospital or service if referred by a GP for a physical or mental health condition, including some private hospitals that provide services to the NHS without incurring additional costs. You also have the option to select a clinical team led by a consultant or specified healthcare professional, provided that they offer the treatment you need.
Did you know?
If a GP needs to refer you for a physical or mental health condition, in most cases, you have the legal right to choose the hospital or service you'd like to go to. This will include many private hospitals if they provide services to the NHS and it does not cost the NHS any more than a referral to a standard NHS hospital.
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You can also choose a clinical team led by a consultant or named healthcare professional, as long as that team provides the treatment you require. Find out more about choosing a hospital or consultant and choosing a mental health service.
You can book your appointment via the NHS e-Referral service. It can be done while you're at the GP surgery, or online, using the shortlist of hospitals or services provided in your appointment request letter. The shortlist is selected by your GP, so make sure you tell them about your preferences during the appointment. You have the legal right to ask for your appointment to be moved to a different provider if you're likely to wait longer than the maximum waiting time specified for your treatment.
The hospital or integrated care board (ICB) will have to investigate and offer you a range of suitable alternative hospitals or clinics that would be able to see you sooner. Read the guide to waiting times for more information.
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Are conditions trickier to diagnose when appointments are remote?
Ms McGarry says any condition that requires visual assessment or physical touch is more difficult to assess and diagnose correctly when an appointment is carried out remotely. This can include infections, chest pain, and abdominal pain. It is important for a patient to be able to show the GP exactly where the pain is and for the GP to palpate the area to establish exactly where the pain is.
Assessment of a lump or changes to the skin
The solicitor says it is important to visualise and feel the lump to ascertain where it is located, its size, whether it is hard or soft, and whether it is painful when touched. Then, the solicitor says it is important to compare the visualisation and feel of the affected side of the body with the unaffected side of the body.
All guidance for early detection of cancers revolves around knowing your body, feeling your body and noticing changes, not to look at photographs. The GPs need to see and feel a lump to decipher whether or not it is suspicious and requires further investigation / onward referral, and on what basis that referral should be made, either routine or an urgent two-week suspected cancer pathway.
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Visual or physical internal assessments
Ms McGarry said: "An example is a digital rectal examination to assist in diagnosing prostate cancer, or vaginal examinations with a speculum to visualise cervical abnormalities, assisting in the diagnosis of cervical cancer. GPs need to see and feel the prostate or cervix to decipher whether or not there are suspicious features which require further investigation / onward referral. They need to consider on what basis the referral should be made, either routine or an urgent two week suspected cancer pathway."
Do any conditions require intimate examinations?
NHS England says: "It is not advisable to encourage patients to send clinical images of intimate regions or reveal or self-examine intimate areas during a remote consultation. The GMC is clear that all patients should be offered a chaperone. Patients who require an intimate examination should, therefore, be encouraged to attend for a face-to-face assessment."
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Limb ischaemia requires assessment of peripheral pulses to determine whether they are weak or absent. Limb ischemia refers to a reduced blood supply to the limbs, potentially affecting the arms or legs. Other conditions that require intimate examination can include:
Any condition requiring the assessment of temperature or blood pressure.
Visual assessment of eyes, ears or mouth.
Assessment of any orifice or skin abnormalities.
What if you feel you've been misdiagnosed over the phone or in a video consultation?
Ms McGarry adds: "If you believe that you have been misdiagnosed over the telephone or in a video consultation at the time of your assessment, you can ask your GP to arrange an in-person appointment for further assessment, examination or testing and explain why you feel a face-to-face appointment is necessary.
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"If that particular GP will not arrange an in-person appointment with you, you can call the surgery to make a further appointment and request an in-person appointment for a second opinion and further assessment, examination or testing and explain why you feel a face-to-face appointment is necessary.
"For example, you could advise that you are very concerned that the lump you have located is suspicious and you feel a physical appointment is necessary so that the GP can see and feel a lump to decipher whether or not it is suspicious and requires further investigation / onward referral and on what basis that referral should be made. If the GPs continue to refuse to examine you in person, you could ask for the matter to be escalated to the Practice Manager."
If your condition is urgent or deteriorating after a telephone or video consultation, you should take appropriate action by attending a walk-in centre, urgent care centre or A&E, depending on the severity of your condition and your level of concern.