Just over half of GP appointments in Greater Manchester are now carried out remotely - part of a digital health service that, to some extent at least, is here to stay.
The latest data from the NHS reveals just 54pc of patients in the area were seen face-to-face, including during home visits, by their GP in August.
That compared to 51pc in January, during the winter lockdown, and 80pc in February 2019, before the pandemic hit the UK.
And it’s understood that, although patients can request in-person appointments, video and telephone consultations are here to stay, although at what levels remains to be seen, because the pandemic brought forward plans for a more digital approach which were already in the pipeline.
The ratio of face-to-face to remote appointments varies widely across the region.
In Salford, 43pc of patients were said to be in the surgery or home, compared to 63 in Wigan.
In Bury, meanwhile, the in-person figure was 3pc, however due to an ‘IT issues’, in the majority of cases (97pc) it wasn’t known whether they were face-to-face or remote which renders this inaccurate.
To compensate for the 8pc of appointments in Greater Manchester which are ‘unknown’ - again said to be caused by IT issues - regional health bosses have bumped the figure of face-to-face appointments up to 56pc, in line with the national average.
Dr Fareeha Saeed, a GP at Failsworth Group Practice who describes herself as 'overworked and unappreciated' said she’s been seeing 28 of her 35 daily patients.
She said they were also dealing with staffing challenges, combined with flu jabs, boosters, a huge backlog of patients who held back during the pandemic, and the need for infection control, are all adding pressure.
“Covid is still there, we are still dealing with it,” added Dr Saeed, who argues the NHS needs a ‘structural overhaul’.
“And on top of that verbal and physical abuse has gone sky high.
“They need to let us use our judgement and medical knowledge to decide who we see.”
Dr Tom Tasker, GP and chair of Greater Manchester Health and Social Care Partnership’s medical executive said: “We know GPs are often the first point of contact for people concerned about their health and wellbeing and just how important it is that the public are able to access general practice when they need to."
He said the pandemic had brought forward a 'number of changes' that were already underway in Greater Manchester around providing more choice on appointment types available for people.
He added: "This led to a rapid transformation in the early part of the pandemic whereby we moved from a largely face-to-face model to one of remote consultations e.g. phone, video and online to support patient and staff safety whilst still maintaining services."
He said Covid levels remained high and that the system reduced the risk of transmission in GP practice waiting areas and consulting rooms, adding: "We are protecting the most vulnerable members of the public in line with government advice."
He said they were working hard to provide in-person appointments where possible for those who wanted them and in cases where it was clinically appropriate - and that GP receptionists had a key role in this.
Dr Tasker did accept there was work to be done.
He added: " We recognise that we have more to do to guide the public in understanding how general practice is currently working including what appointment options are available and appropriate for individual needs, and that are condition specific."
He said the total number of appointments in general practice was 'significantly higher' than pre-pandemic, in part due to the new range of options, but also due to increased demand.
He added: “We know that for many people, it can sometimes feel difficult to get through on the phone, and there isn’t always a way to leave a message or use a digital option; this is something we are changing to help the public get through for support.
"We want to reassure the public that we are trying exceptionally hard to meet high levels of demand and respond to all those who need advice and care.
"We ask the public to understand the pressure on our services and that we are busy seeing thousands of people across Greater Manchester each and every day.”
Meanwhile, 35pc of dental practices have said they are ‘challenged but coping’, with around 8pc reporting ‘significant challenges.
Around a quarter of pharmacies say they are ‘challenging but coping’, while a third of optometry practices report the same.
Issues with accessing GPs have had a knock-on effect on other services, with A&Es busier than ever during the summer, and deteriorating ambulance response times - with reports of ambulances queuing outside emergency departments.
Analysis by the Royal College of Emergency Medicine (RCEM) showed a lack of access to GPs has been a key factor in this increased pressure - particularly with older people, those with disabilities and families on low incomes.
Both the government and NHS England say more patients should have face-to-face consultations - and that GPs are being given the money to provide them.
But speaking to the BBC, Royal College of GPs chair Professor Martin Marshall said: "The workforce is simply not big enough to manage."
Separate figures from the NHS show that there are currently 1,384 full-time GPs in Greater Manchester, excluding locums and trainees.
That’s up slightly from 1,372 in 2020, but down from 1,427 five years ago in 2016 - despite a government drive to increase GP numbers.
Prof Marshall said that GPs strive to deliver the same high-quality care whether a consultation is remote or in person, and that some patients prefer remote consultations as they can be more convenient and fit around other commitments.
However, he added: "Remote consulting will not always be appropriate. This is why in person appointments are being made - making up almost six in ten consultations in August - and have been throughout the pandemic when they've been necessary.
“Face to face consulting will always be an essential part of general practice, and as we move out of the pandemic, we want to see a blended approach with decisions about how care is delivered being a joint one between GP practices and their patients.
"Ultimately we need more GPs and other members of the practice team to deliver the care our patients need. The Government needs to act now to address this by working to build the GP workforce by at least the 6,000 full-time equivalent family doctors that have been promised, as well as other members of the practice team, and address the 'undoable' workload in general practice that is leading to trained family doctors leaving the profession earlier than planned.”
Across England as a whole, more than 80pc of patients were seen face-to-face either in the surgery or at home before the pandemic.
During the first lockdown in spring 2020, that proportion fell below 50pc, and has remained low ever since - hovering between 50pc and 60pc all this year.
A Department of Health and Social Care spokesperson said: “We’re hugely grateful to GP practices for their hard work and dedication to bringing appointment numbers back to pre-pandemic levels, with over 330 million delivered in the last year.
“As has always been the case, we are clear GP practices must take the preference of the patient on board and provide face to face appointments to those who want them, alongside remote consultations.
“We are investing £270 million to expand GP capacity, on top of providing £1.5 billion for general practice until 2023/24 to deliver world-class care to patients.”
