Seeing a GP has often started with a phone call, but the COVID-19 pandemic has taken it a step further.
Once the exception, telemedicine — the practice of caring for patients remotely — suddenly became a crucial part of primary care in the UK. While many have embraced the convenience of digital consultation, others have expressed concerns about remote care, worrying it could lead to missed or delayed cancer diagnoses.
And with the arrival of a new variant and plans to speed up the delivery of booster jabs, fears over access to GPs have been renewed.
So how does the shift to more remote consultations affect cancer patients and those suspected of having cancer?
What is ‘remote first’ and is it here to stay?
At the start of the pandemic, GP surgeries were instructed to limit in-person contact with patients and favour phone and video consultations — conducting face-to-face appointments only when necessary. The measures were introduced to protect healthcare workers and patients, and to reduce the spread of COVID-19.
In April 2021, NHS England briefly considered making this remote-first approach standard practice, but the move was met with such backlash — from patients and doctors alike — that it quickly rowed back. GPs were instead told to respect patients’ preferences when it came to appointments.
But GPs are finding it increasingly hard to do this. In August 2021, a Cancer Research UK survey of 1,000 UK GPs found that two thirds were struggling or could not meet the demand for in-person consultations — an almost 50% increase from February.
Too much work for too few GPs
“People forget that during the winter of 2019, prior to COVID-19, they were already having to wait 3 weeks for a routine appointment,” says Dr Joe Mays, a GP partner in Exmouth and Cancer Research UK GP lead for Peninsula Cancer Alliance. “The bottom line is not how we access our GP, but how much GP time there is.”
In 2015, the Conservative Government pledged to improve access to primary care by increasing the number of GPs by 5,000 by 2020. This commitment was reiterated in 2019 — this time with a promise to recruit and retain 6,000 new primary care doctors by 2024.
Instead, the British Medical Association estimates that the number of fully qualified full-time equivalent GPs in England has fallen by 1,803 since 2015.
Not only are there too few GPs, but primary care is facing ever-growing demand and an increasingly complex workload.
And now they’re being asked to lead the UK’s vaccination efforts once again.
“Most GPs will tell you they’ve never worked harder,” says Mays.
In October 2021, GPs logged 30.2m appointments, which is on par for the same month in 2019.
Despite this, patients are finding it harder to get appointments when they need them. According to our September 2021 Cancer Awareness Measure (CAM) survey of 2,446 UK adults, 65% of people said it was harder to get an appointment (remote or in-person) with a GP now than before the pandemic.
Benefits vs risks of remote appointments
With the health service under increasing pressure can virtual appointments play a role?
“It can be an extremely efficient way of addressing people’s problems,” says Mays, whose practice in Exmouth has conducted about half its consultations remotely since 2015.
Not only does it reduce the need for patients to travel or take time off work, but it allows GPs to deal with simple cases quickly and efficiently, he explained.
But it doesn’t work for everyone. And in some cases, it can create more work and potentially delay diagnosis. “There is a risk that the total amount of time you spend assessing somebody is actually greater,” says Mays.
Remote appointments also don’t allow for the same level of examination and testing, which could impact diagnosis of certain cancer types. For example, experts at Cancer Research UK believe the drop in number of urgent referrals for suspected urological cancer is partly due to GPs not being able to carry out point-of-care tests, such as urine dip tests, which look for invisible traces of blood in wee.
But more research is needed to fully understand the impact of remote consultations on cancer diagnosis.
What does this mean for cancer patients?
Like many others, Zoe found it difficult and frustrating to access her GP in summer of 2020, after discovering a lump in her right breast.
A healthy 23-year-old, she didn’t think much of it. But her mum insisted she see a GP, just in case.
This was during the early days of the pandemic when remote-first appointments were still in place. So, Zoe filled out an online form and waited for the GP to call. The conversation didn’t last long. Zoe explained she needed to be examined and was given an in-person appointment in a few weeks’ time.
The GP wasn’t particularly concerned about the lump, but referred Zoe to a breast clinic, where she was again given a telephone appointment before being seen in person.
“It felt like a waste of my time,” she said of the remote-first approach. “Luckily for me it wasn’t harmful, but for other patients a few weeks could be detrimental.”
In August 2020, Zoe was diagnosed with a rare case of stage 0/1 DCIS and triple-positive breast cancer. Her cancer was caught early, but this unfortunately might not be the case for everyone whose care has been disrupted by the pandemic.
Keep ringing until you get through
It will be a while before we know if COVID-19 has led to increased cancer deaths. But it’s estimated that nearly 45,000 fewer patients started treatment for cancer in the UK during the first year of the pandemic.
It’s hard to say what exactly caused this reduction but pauses to cancer screening programmes and people not coming forward with symptoms are likely to have contributed.
In September 2021, our CAM survey found that people are still hesitant to come forward because they don’t want to overburden the healthcare system. Not wanting to waste healthcare professionals’ time (13% of respondents) and not wanting to make a fuss (13%) were among the top 5 reasons people were put off or delayed seeking medical help.
But the most common reason was that they found it difficult to secure an appointment (17%).
“Knowing what to go to the doctor with, and when, has never been straightforward and it can be easy to put health changes out of your mind,” says Dr. Jodie Moffat, head of early diagnosis at Cancer Research UK. “But if you notice something unusual in your body, it’s important to get it checked out. Chances are it won’t be cancer, but if it is, spotting it early can make all the difference.”
“And if you have trouble getting an appointment, please do keep trying.”
Michelle Ferguson is a health media officer at Cancer Research UK