IMO GP Chair disputes remote consults claim

The Chair of the IMO GP committee has disputed assertions by the Irish Association for Emergency Medicine (IAEM) that remote consultations in general practice are driving increased emergency department (ED) attendances.

In a recent press statement, the IAEM said: “The effects of the large-scale abrupt replacement of face-to-face consultations in general practice with remote/virtual consultation appears to be an independent driver of a significant increase in ED attendances.”

The union’s GP Chair Dr Denis McCauley told Medical Independent (MI) he disagreed with the argument that remote consultations were contributing to increased ED attendances.

“Now, most consultations are face-to-face, so it isn’t really a relevant criticism,” he said. “Telephone consultations are actually very rare.”

Speaking to MI, Dr Fergal Hickey, President of the IAEM, acknowledged the “Trojan work” of GPs and their high workload. However, “we need to recognise the limitations of virtual consultations and they should only be used in clinical scenarios in which they’re appropriate.” Dr Hickey said while remote consultations should continue in some cases, they are “an inferior way of making assessments, particularly in an emergency or acute situation”.

“We’re not there to provide an alternative to outpatient services; we’re not there to provide an alternative to primary care services,” he added. Dr Hickey said patients are presenting to EDs with low-acuity conditions when GP appointments are unavailable or after a patient is assessed remotely and an incorrect referral is made.

In regard to inappropriate referrals, patients who arrive to an ED are assessed and triaged at a level of low-acuity and therefore spend long periods waiting to be seen. “Then when they’re finally seen, it may be very unsatisfactory because the conclusion is [they] didn’t really need to be here in the first place or that this is something that could have been dealt with in primary care.”

At the height of remote consultations during the pandemic, the “safety net” of the Covid assessment hubs helped to prevent “the theoretical situation that they [IAEM] are presenting”, according to Dr McCauley.

He said the surge in ED presentations is also attributable to delayed diagnoses, delayed access to tests and patients presenting with latter stage diseases due to the pandemic.

He also said the fact some hospitals have not fully resumed outpatient services has contributed to the increase in ED attendances. Dr Hickey agreed with these points.