Why are Sajid Javid and GPs in England engaged in a war of words? The health secretary has irritated GPs by making clear he wants them to provide more face-to-face appointments rather than speaking to patients on the phone or by video call. Tension between GPs and Javid has grown over the past few weeks, with family doctors describing the minister as ignorant of the huge strain they are under. The number of face-to-face appointments fell dramatically during the pandemic as GP surgeries followed NHS and government advice to use remote appointments as far as possible, to ensure the safety of patients and practice staff. But the proportion of all GP appointments that are held in person is now back to 58%, the most recent figures show. Before the pandemic it was 80%. Javid wants GPs to offer a face-to-face consultation to anyone who wants it. In his speech to the Conservative conference last week, he said: “The public … expect to be able to see their GP, in the way that they choose.” How does that relate to the new ‘support plan’ for GPs? He enshrined the in-person-if-wanted principle in this controversial policy initiative, which launched on Thursday and is intended “to improve access for NHS patients and support GPs”. It made GPs’ ability to share in a new £250m “winter access fund” dependent on patients being able to select how they interact with the GP, and surgeries offering more face-to-face appointments as well as more slots with a GP or practice nurse for patients who call on that day. From next spring the NHS will publish monthly figures showing how many patients were seen in person – a move that some GPs claim will “name and shame” surgeries that do not deliver enough face-to-face care, perhaps because they are understaffed, as many are. What do GPs say about that? GPs’ leaders have become increasingly uneasy with the language used recently by Javid, Jacob Rees-Mogg and the prime minister’s official spokesperson on Boris Johnson’s behalf. They worry that the exhortations for GPs to see more patients in person are unrealistic because of the continuing threat from Covid and, in particular, the widespread shortage of GPs and their heavy workloads. “It’s truly frightening that we have a government so ignorant as to the needs of such a core part of the NHS,” said Dr Richard Vautrey, the chair of the British Medical Association’s GP committee. Prof Martin Marshall, the chair of the Royal College of GPs (RCGP), said Javid’s plan was “a missed opportunity that will do little to improve the intense pressures” surgeries face. For family doctors, the lack of GPs and the difficulty surgeries have in filling posts that become vacant, is the most pressing issue they face, not how they deal with patients. The government promised in 2015 to expand the GP workforce in England by 5,000 by 2020, but missed that target. Johnson has pledged to increase the number of GPs by 6,000 by 2024. However, the number of full-time equivalent GPs in England fell from 29,403 in 2015 to 28,023 in August – a drop of 1,380. The total number of GPs has risen over that time, from 36,120 to 38,792. But the total amount of GP time has shrunk as more family doctors have opted to work part-time. What are GPs saying about the government’s plans? The BMA and RCGP are angry that the government has, in its new action plan, required the return of routine face-to-face appointments but taken few of the steps they had suggested would help relieve the strain caused by the ageing and growing population and the ever-growing demand for care created by Covid. For example, they wanted to see the suspension or scrapping of the Quality Outcomes Framework, a system under which GPs are paid for monitoring patients with long-term conditions such as asthma and diabetes, to reduce the number of patients they have to see every day. They would prefer to see ministers delivering on the promises to expand the GP workforce by 6,000 and help surgeries hire 26,000 more staff by 2024. Why do face-to-face appointments matter so much? Most patients still prefer to see a GP in person, because of the privacy involved. Some GPs believe that what the BMA calls the government’s “preoccupation with face-to-face appointments” is a response to a continuing campaign by the Daily Mail, and other coverage in the Daily Telegraph and Times, that family doctors have interpreted as “GP bashing”. Ministers say doctors may miss signs or symptoms of illness or injury if they do not see someone in the flesh, partly because they then cannot perform a physical examination. Dissatisfaction about the difficulty of getting a GP appointment had been growing among patients even before the pandemic struck in spring 2020, with delays of two weeks. There is some evidence that patients are going to A&E in frustration at not being able to see a GP. The BMA and RCGP both point out that not only are there too few GPs to seeeveryone who wants an appointment, but also that some patients prefer a telephone or video consultation and that some routine tasks, such as medication reviews, can be done safely remotely.