‘Bad old habits’ … and what really matters

Abstract

Thank you for publishing our article 'Revealing the reality of undergraduate GP teaching in UK medical curricula' in which we highlighted the longstanding problem of underinvestment in general practice teaching in the UK. 1 One of our key recommendations was for 'an adequate primary care tariff, which reflects the cost of teaching and simplifies current payment mechanisms'. We are pleased to report that since writing this paper the Department of Health and Social Care (DHSC) in England has for the first time introduced a national minimum tariff for medical student placements in general practice. 2 We of course welcome this development as a step in the right direction. However, the new minimum tariff of £28 000 per full-time equivalent (FTE) placement per year still falls significantly short of the current tariff for secondary care undergraduate medical placements set at £33 286. 3 A primary care payment of £28 000 per FTE is also significantly lower than the actual cost of undergraduate teaching in general practice, identified by a national study in England as £41 700 per FTE. 4 While there is no doubt that the health economy will be struggling in the wake of the COVID-19 pandemic, recent events surely present yet further evidence of the need to provide all future doctors with highquality experience in general practice and primary care. We strongly urge governing bodies to move fully to a fair and flat tariff for undergraduate placements from 2021 onwards if they are committed to training the future medical workforce that the NHS will surely need.

Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics

“…Our findings affirmed published claims that remote consulting is cognitively burdensome ( 54 ), excludes the physical touch on which the therapeutic relationship has traditionally depended ( 55 ), threatens continuity of care ( 7 ), brings greater clinical uncertainty, and makes the personal care afforded by the extended, face-to-face “long consultation” more difficult ( 8 , 56 , 57 ). For example:…”

“…Primary care clinicians welcomed the infection control benefits, empty waiting rooms, and slackening of red tape that accompanied the initial shift to remote (5). But they also warned of an uncomfortable "brave new world" characterized by fewer consultations overall, loss of continuity of care, threats to the clinician-patient relationship, inequalities of access, and clinical risks (6)(7)(8)(9). Lay media coverage of remote consultations mirrored this pattern, with an initial positive response followed by stories of inaccessibility, missed diagnoses and patients feeling "fobbed off " with phone calls (10,11).…”

Unintended consequences of online consultations: a qualitative study in UK primary care

“…16 Additionally, it is also important to be attuned to the wider consequences of reshaping primary care with technologies that push in the direction of simple, remote, transactions, and away from holistic face-to-face care. 39,40  Allow patients to address online consultations to their preferred GP or show the rota of available GPs, so that patients can address a specific GP.  Filter online consultations from specific patients to specific GPs to maintain continuity of care where it is necessary.…”

‘From disaster, miracles are wrought’: a narrative analysis of UK media depictions of remote GP consulting in the COVID-19 pandemic using Burke’s pentad

“…In June 2020, the British Journal of General Practice was still publishing hopeful narratives, asking ‘ how does general practice identify, develop, and embed the positive changes [towards remote care] that are being implemented as a consequence of the crisis?’ ( Marshall et al 2020 ). But by autumn 2020, remote care had begun to be depicted as potentially damaging to the core values of general practice because it carried risks and threatened the quality of the therapeutic relationship and continuity of care ( Gray et al 2020 ; Swinglehurst et al 2020 ).…”

“…(Marshall et al 2020). But by autumn 2020, remote care had begun to be depicted as potentially damaging to the core values of general practice because it carried risks and threatened the quality of the therapeutic relationship and continuity of care Swinglehurst et al 2020).…”