- Less individual counseling ‘disrupts’ care for pregnant women, report finds
- Doctors and midwives are less likely to detect potentially fatal complications
- TeaHere are 45 so-called ‘intrapartum stillbirths’ in England from April-June 2020
- Review of incident reports finds pandemic exacerbates existing security risks
A lack of in-person GP appointments during the pandemic could lead to an increase in stillbirths, a damning report has warned.
The Healthcare Safety Investigation Branch said stillbirths were 88 per cent higher than pre-Covid levels last year.
Its investigation in 37 cases found that the move to remote appointments ‘inhibited’ the ability to conduct critical investigations.
Last week a senior coroner ruled that a lack of face-to-face GP appointments contributed to the deaths of five people.
There are now a third fewer people seeing their GPs in person than 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 continue to encourage the practice more than a year after the original lockdown, with doctors offering bonuses to keep attendance low.
Health Secretary Sajid Javid fired a warning shot at GPs in the Commons earlier this week, saying: ‘GPs should offer face-to-face access.’
Health Security Investigation Branch report found fewer individual consultations ‘interrupted’ care with fewer opportunities for physical examinations (file photo)
The number of face-to-face GP appointments dropped dramatically at the start of the pandemic, as virtual appointments were encouraged in an effort 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, figures are still far below 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 24 during the same period in 2019.
These are deaths where a baby was thought to be alive at the beginning of delivery, but was born, beyond 37 weeks of gestation, with no signs of life.
Move away from in-person appointments ‘contributing to at least five patient deaths’
A coroner has concluded that remote GP appointments may have contributed to the deaths of five people who had not seen their doctor in person.
The senior coroner for Greater Manchester Alison Mach warned that doctors missed important details in telephone appointments that could have been seen when viewed face-to-face.
Fadhia Seguleh – who had phone call appointments with her GP about her anxiety and depression, which Kone warned made it harder to assess her needs – committed suicide at her home on February 25.
Ms Mach also had concerns about the role of remote doctor’s appointments in the deaths of three other people who died of a fatal blood clot in the lung, undiagnosed Covid and a drug overdose.
And the fifth patient, a frail elderly man with serious underlying health conditions, died after breaking a bone that the hospital doctors and his GP had not seen in a phone call consultation.
Experts have long warned that shying away from in-person appointments can lead to misdiagnosis.
There are now a third fewer people seeing their GP in person than before the pandemic and 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 to in-person appointments, if necessary, in an effort to prevent the spread of the virus.
In May, as infection levels were falling, NHS England in May ordered GPs to offer remote as well as in-person appointments to all patients and cash bonuses to meet virtual consultation goals been offered.
But doctors condemned the move and the British Medical Association’s GP committee termed the move as ‘totally unfair and dangerous’.
Most of the stillbirth deaths were due to problems with the placenta and disturbances in the flow of blood to the baby.
Nineteen infants had no signs of life at the first visit to the hospital during delivery. But 11 of these women had contacted the telephone for advice and were advised to stay at home.
In one case, the mother chose not to attend an appointment at the clinic for fear of getting infected with the coronavirus.
In all the cases reviewed, the women attended no more than six face-to-face appointments.
A review of incident reports by the HSIB found that the pandemic exacerbated existing safety risks such as staff shortages and created new ones.
The HSIB report says: ‘The proportion of remote consultations is not known and the effect of remote consultations is unclear … However, there was evidence that distance consultations impede some activities.
‘Notably, there were fewer opportunities for physical examinations, thereby limiting the opportunity to establish trends [growth] Measurement.’
Investigators said the pandemic has reduced the continuity of care for women who have failed to see the same midwife at each appointment.
The disruption also meant that staff were sometimes unable to access patient records needed to inform clinical decision-making during consultations.
This resulted in three times the ultrasound scan was canceled or not provided and in one case there was a major change in the intended birth plan.
The Royal College of Obstetricians and Gynecologists and the Royal College of Midwives issued guidance during the pandemic, emphasizing the need to maintain six face-to-face consultations in antenatal care. Maternity units were told to ‘maximize use’…