Uncertainty over a GP surgery’s requirement to hold face-to-face consultations could lead to more misdiagnosis and delayed diagnosis, and more fatalities.

At Ison Harrison, we are calling for clearer guidelines and leadership on the issue of face-to-face GP consultations, to reduce the risk of the tragic David Nash case being repeated.

David Nash was a 26-year-old law student in Leeds who contacted his GP on four occasions between October 14th and November 2nd 2020 with varying complaints. However, he was denied a face-to-face consultation with his GP, and was even refused admittance to the surgery on November 2nd for a pre-planned blood test, because he was experiencing fever-like symptoms. David had suffered from chronic media otitis since childhood, a condition that was well known and documented on his medical records. He was admitted to hospital later on November 2nd and died two days later.

The father of David Nash is seeking to establish whether medical negligence contributed to his son’s death, at an upcoming inquest, and this has raised the subject as to whether non-face-to-face consultations are leading to a risk of misdiagnosis, delayed diagnosis and deaths which could have been prevented by appropriate GP care and attention.

GP appointments moved online during the pandemic

Many GPs moved to online appointments only during the COVID pandemic and have yet to return to normal face-to-face practices despite the lessening of restrictions during 2021. GP practices are now under pressure to open themselves back up to face-to-face appointments, at least where it is felt appropriate, as in the tragic case of David Nash.

In October 2021, the NHS announced a £250m winter access fund, with specific instruction that the amount allocated to a practice should be dependent on how many in-person appointments a practice had offered. Further pressure is being heaped on GPs by the plan for all GP surgeries to publish data in spring 2022 on how many patients they are seeing face-to-face, and data on waiting times. The Government feels this will give NHS bosses clearer information on the effect of non-face-to-face consultations and appointments but, as the case of David Nash demonstrates, that doesn’t help people who have health problems in the here and now and face that sometimes desperate need to seek appropriate medical attention straight away.

On the flipside, GP leaders are warning of a “crippling exodus” of family doctors who claim that they are already exhausted by the pandemic, if in-person appointments are made mandatory again. The GP profession claims they are being pilloried by Government ministers for perceived inactivity, when they say the reality is they have been at the sharp end of the pandemic for 18 months. The feeling is that GP surgeries having to publish figures on in-person appointments is a concerted effort to “name and shame” GPs who are not complying with instructions to open up their surgeries to physical appointments again.

Could misdiagnosis or delayed diagnosis have caused David Nash’s death?

As ever, it is felt that there should be some common ground to find a practical, common sense solution to the issue. The tragic case of David Nash highlights the need for appropriate care and attention in circumstances where there is critical medical information that may not be available otherwise than in a face to face setting. The upcoming inquest on David Nash’s death, and the subsequent verdict, is expected to add considerably to the debate as to whether or not non-face-to-face appointments are risking the possibility of misdiagnosis or delayed diagnosis, particularly in cases where a timely diagnosis could be critical. This coincides with the Cancer Research UK campaign #Cancerwontwait, which is highlighting the need for timely diagnosis in the context that every day is critical where cancer is concerned.

Currently there is no clear guidance on when and why a GP surgery needs to open itself up to face-to-face appointments, and this uncertainty is causing anxiety among patients who can’t be reassured with clear information about the standard of care they should expect. The case of David Nash is an extreme example of how the delivery of ‘appropriate care’ can go wrong, but it also highlights the problem that there is nothing in place to prevent this happening again, and when a GP’s duty is to patients under the surgery’s care, then a clear resolution to this issue is in everybody’s interests.

For advice regarding delayed diagnosis or misdiagnosis, please call us on 0113 284 5000 or email clinneg@isonharrison.co.uk

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