A lack of in-person GP appointments during the pandemic may have led to a surge in stillbirths, a damning report has warned.
The Healthcare Safety Investigation Branch said stillbirths were up 88 per cent last year compared to pre-Covid levels.
Its investigation into 37 cases found the move to remote appointments ‘impeded’ medics’ ability to carry out vital checks.
It comes after a senior coroner last week ruled that a lack of face-to-face GP appointments contributed to the deaths of five people.
A third fewer people are seeing their GP in-person now compared to before the pandemic and tens of millions of appointments were ‘lost’ during the Covid crisis.
GPs were urged to conduct all consultations remotely and strongly encouraged not to invite patients for an in-person appointment unless they deemed it an emergency.
But trusts have continued to incentivise the practice more than a year after the original lockdown, with doctors being offered bonuses to keep attendances low.
Health Secretary Sajid Javid fired a warning shot at GPs in the Commons earlier this week, telling them: ‘GPs should be offering face-to-face access.’
Fewer in-person consultations ‘impeded’ care with fewer opportunities for physical examinations, the Healthcare Safety Investigation Branch report found (file photo)
The number of GP appointments taking place face-to-face dropped dramatically at the beginning of the pandemic, as virtual appointments were encouraged in an attempt to keep social mixing low and hospitals virus-free. In-person appointments began to increase last summer, before dropping again during the second wave. Despite being on the rise, the figures are still much lower than pre-pandemic levels
The HSIB said there were 45 so-called ‘intrapartum stillbirths’ in England from April to June last year – 88 per cent more than the 24 during the same period in 2019.
These are deaths where a baby was thought to be alive at the start of labour but was born, beyond 37 weeks of gestation, with no signs of life.
Move away from in-person appointments ‘contributed to at least five patient deaths’
Remote GP appointments may have contributed to the deaths of five people who did not see their doctor in-person, a coroner has concluded.
Doctors missed important details in telephone appointments that may have been spotted if they were seen in face-to-face, senior coroner for Greater Manchester Alison Mutch warned.
Fadhia Seguleh – who had phone call appointments with her GP about her anxiety and depression, which the corner warned made it harder to assess her needs – committed suicide in her home on February 25.
Ms Mutch also had concerns about the role of remote doctor appointments in the deaths of three other people, who died from a fatal blood clot in the lung, undiagnosed Covid and a drug overdose.
And a a fifth patient, who was a frail elderly man with a host of severe underlying health conditions, died after breaking a bone that wasn’t spotted by hospital doctors and his GP in a phone call consultation.
Experts have long-warned that moving away from in-person appointments can lead to missed diagnoses.
A third fewer people are seeing their GP in-person now compared to before the pandemic and tens of millions were ‘lost’ during the Covid crisis.
When the Covid crisis hit the UK, GPs were urged to conduct all consultations remotely and only invite patients for an in-person appointment if it was necessary, in an attempt to curb the spread of the virus.
In May, as infection levels were dropping, NHS England ordered GPs in May to offer all patients in-person appointments alongside remote ones and were offered cash bonuses for meeting virtual consultation targets.
But doctors condemned the move and the British Medical Association’s GP committee labelled the move ‘completely inappropriate and dangerous’.
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The majority of the stillbirth deaths occurred due to problems with the placenta and compromised blood flow to the baby.
Nineteen babies had no signs of life on the first visit to hospital during labour. But 11 of these women had made telephone contact for advice and were advised to remain at home.
In one of the cases, the mother chose not to attend an appointment for fear of catching coronavirus at the clinic.
In all of the cases it reviewed, the women attended more than six face-to-face appointments.
A review of the incident reports by the HSIB found the pandemic exacerbated existing safety risks such as staff shortages and created new ones.
The HSIB report says: ‘The proportion of consultations undertaken remotely is not known and the impact of remote consultations is not clear… However, there was evidence that remote consultations impeded certain activities.
‘Specifically, there were fewer opportunities for physical examinations to be carried out, limiting the opportunity to establish trends for [growth] measurements.’
Investigators said the pandemic led to a reduction in continuity of care with women failing to see the same midwife at each appointment.
Disruption also meant staff were sometimes unable to access the patient records needed to inform clinical decision making during consultations.
Three times this resulted in ultrasound scans being cancelled or not being made available and in one case there was a major change to the intended birth plan.
The Royal College of Obstetricians and Gynaecologists and Royal College of Midwives issued guidance during the pandemic that emphasised the need to retain six face-to-face consultations in antenatal care. Maternity units were told to ‘maximise the use’ of remote consultations for additional appointments.
The HSIB made eight recommendations to improve maternity care – saying that the NHS should collect better evidence on what impact remote consultations have had on maternity care and that its telephone triage services should be improved.
Dr Mary Ross-Davie, director of professional midwifery at the RCM, said: ‘While this report doesn’t reflect the full national picture it is nonetheless devastating for the women and their families who have lost their babies… The RCM has been clear in its advice throughout Covid-19 that its crucial women attend in-person appointments with their midwife so observations such as blood tests and foetal growth can be measured.’
An NHS spokesman said they were ‘committed to providing safe, compassionate maternity services’ and that face-to-face appointments were offered to anyone who had concerns during their pregnancy.
He also said that more than 90 per cent of maternity outpatient appointments took place in person between April and June in 2020 and that pregnant women should come forward if worried about their health or their baby.
Recent data from NHS Digital showed 57.2 per cent of appointments in July were conducted face-to-face.
That is higher than the low of 46.8 per cent last April, as the first Covid wave swept across the UK, but much lower than the 80 per cent pre-pandemic figure.
Woman, 27, died from liver cancer after GPs failed to spot tumour for five MONTHS during virtual appointments and refused to see her in-person 
Jessica Brady, 27, died from stage-four cancer in December after struggling to get an in-person appointment with her GP during the pandemic
The mother of a young woman who died from cancer has told MPs her daughter might still be alive if she was seen by her GP face-to-face.
Jessica Brady, 27, from Stevenage in Hertfordshire, passed away from liver cancer in December after a series of virtual appointments over the course of five months failed to spot her tumour.
Her mother, Andrea, told the Health and Social Care Committee today that Jessica was repeatedly denied an in-person appointment after first complaining of abdominal pain last summer, despite the epidemic being largely under control at that point.
She was diagnosed with a kidney infection ‘in the absence of any diagnostic testing or any physical examination at all’ and prescribed with antibiotics.
When she became extremely fatigued and her symptoms worsened, she was only prescribed more antibiotics, steroids, and an inhaler.
One set of blood tests even revealed Jessica had high D-dimer levels, which can be a signal of solid cancers, the mother told MPs.
And subsequent tests identified concerns regarding her liver function – which her mother said makes sense now as she had liver cancer – but medics decided to wait six weeks to see what happened.
Doctors didn’t put ‘the pieces of the jigsaw together’ that it was cancer until five months later, by which point the cancer had spread around Jessica’s body and become untreatable.
It comes as Health Secretary Sajid Javid demanded ‘more GPs should be offering face-to-face access’ and ‘we intend to do a lot more about it’.
Figures show a third fewer people in England are seeing a GP now than before the pandemic and tens of millions of appointments were ‘lost’ during Covid.
Andrea Brady, Jessica’s mother, told MPs her daughter needed a face-to-face appointment ‘really early on’. She was told to get a gastroscopy after in-person appointments, but if this happened a few months earlier, her cancer ‘wouldn’t have spread so aggressively’, Mrs Brady said
Ms Brady revealed that Jessica was only finally seen in person by a GP when she bombarded her local surgery with more than 20 phone calls.
The family doctor told the family that Jessica ‘probably needs a gastroscopy’, her mother told the committee.
If this procedure – which involves a camera taking pictures inside the stomach – happened a few months earlier, her cancer ‘wouldn’t have spread so aggressively’, Ms Brady said.
‘Jess was a very gentle, sweet person, but she really did attribute her late diagnosis to the slow reaction of her GP surgery,’ her mother added.
Even after seeing a GP in-person, it was not until she sought private health care that she was diagnosed with stage four cancer of the lungs, bones, spine and liver.
She went to hospital on the day of her diagnosis and died three and a half weeks later on December 20.
Asked about Jessica’s challenge in getting a GP appointment, she said: ‘It was incredibly challenging for Jess, just navigating the whole system of consult procedures.
‘I think the most important thing is we feel, and Jess felt that no one listened, no one took it seriously and more than anything, she needed a permitted face-to-face appointment really early on, with people making notes.
‘And also, during all that time, she wasn’t seen by one designated doctor, four different doctors spoke to Jess and prescribed her medication. And we think that was really key.
‘No one person was looking at the whole picture and putting the pieces of the jigsaw together. That didn’t happen until two days before Jess received her diagnosis, when I think there was an element of panic, because she was receiving quite a lot of phone calls at that stage, and saying you probably need a gastroscopy.
‘In fairness, if that had happened three months earlier, obviously her cancer would not have spread – well we think it wouldn’t have spread so aggressively by then – so I think it’s fair to say that Jess was a very gentle, sweet person, but she really did attribute her late diagnosis to the slow reaction of her GP surgery.’
Her parents have launched a petition calling for a cancer specialist in every doctor surgery, a dedicated GP for each patient, frequent courses for GPs and a public health campaign on the warning signs of cancer in young people.
In response to Jessica’s case, Dr Richard Roope, clinical adviser for cancer at the Royal College of General Practitioners, told MPs: ‘In general practice we talk about learning events and this is the mother of all learning events.
‘To state obvious, no GP gets up in morning to miss a diagnosis.
‘We are there to help our patients and to enable access to the best treatment and diagnostics in a timely fashion and I think we can do things better than what has happened.
‘And I think the narrative that we’ve heard is in a way a manifestation of essentially demand outstripping supply.
‘That all GPs could do more if we had more time and if there was more GPs we could give more time to each patient.’
It comes as the Health Secretary said today that ‘everyone can understand’ why GPs ‘couldn’t provide access in the normal way’ during the peak of the coronavirus pandemic.
But he said ‘we are way past that now’ and doctors should be following society in going back to ‘completely normal’ life.
He said that ‘more GPs should be offering face-to-face access’ and ‘we intend to do a lot more about it’.
Virtual appointments were heavily encouraged throughout the Covid crisis in an attempt to keep social mixing low and hospitals virus-free.
But trusts have continued to incentivise the practice, with GPs being offered bonuses to keep in person attendances low.
There are fears that some people, particularly the elderly, are being left behind.
Recent data from NHS Digital showed 57.2 per cent of appointments in July were conducted face-to-face.
That is higher than the low of 46.8 per cent last April, as the first Covid wave swept across the UK, but much lower than the 80 per cent pre-pandemic figure.
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