Why face-to-face still saves lives

Edoardo Cervoni is a GP in Merseyside, England, with a background in ENT and a long-standing fascination with how people heal, not just biologically, but through relationships, attentiveness, and continuity.

IImagine this: It is the the early morning, first appointment of the day, you find yourself staring at the door after the patient leaves and thinking: we are sleepwalking into danger.

A man in his late fifties books a face-to-face appointment for upper back pain. You would not normally feel comfortable assessing thoracic pain remotely and today reminds you why.

As he sits down and adjusts his collar, you notice a small, pigmented lesion tucked high behind the helix of his left ear — a place few people ever see clearly, and one he himself has never thought to photograph, mention, or inspect. It looks irregular. He had no idea it was there.

You manage his pain but also arrange an urgent cancer referral. The lesion, you later learn, is melanoma in situ. Its position, difficult access, and subtle spread mean he now faces a more extensive excision than might have been required months earlier.*

This is not just an “incidental finding.” It is the irreplaceable value of physical presence — the quiet, unglamorous diagnostic safety net that underpins the entire craft of general practice.

Yet the 2025/26 GP contract and accompanying guidance on digitally enabled triage make online tools the required first point of contact for all core hours. Practices failing to comply face financial and contractual consequences.¹ The message is clear: remote first, face-to-face only when necessary.

We are told these systems are safe, but no publicly available evidence has yet demonstrated that a mandated digital-first model reliably identifies or safely triages patients with skin lesions, neck lumps, weight loss, abnormal gaits, subtle neurological signs, or concerns that only become apparent when a person walks into the room. Much of what we diagnose is not what the patient planned to discuss.

Although official guidance states that patients may request face-to-face appointments,² in practice many platforms are configured — and some commercial providers openly market — design features that steer patients away from physical attendance, marking such requests as “inappropriate” or requiring justification. What was once the norm is reframed as an exception.

Remote consulting is excellent for repeat prescriptions, routine results, straightforward infections in the young and well, and selected mental health follow-ups. But general practice is not primarily populated by the young and well. It is a world of the elderly, the multimorbid, the uncertain, the embarrassed, and those who lack the clinical vocabulary to describe what matters most.

Some diagnoses — and some harms — are only visible when the patient is physically present.

Until robust, real-world evidence shows that a mandated digital-first model does not delay cancer diagnoses, widen inequalities, or increase avoidable harm, I will continue to insist that face-to-face remains the gold standard for any new problem, any evolving concern in patients over 50, and for all young children.

Because some things are still only visible when the patient walks through the door.

*Author’s note: whilst this case is fictional and does not relate to any one specific individual, it does derive from the author’s clinical experience and insight.

Deputy editor’s note – see further on the theme of remote consultation safety:

1. https://bjgplife.com/mitigating-safety-incidents-in-remote-consultations-insights-from-new-research/
2. https://bjgplife.com/remote-consultations-convenience-for-some-barriers-for-others/
3. https://bjgplife.com/telephone-consultations-do-not-form-lasting-memories/

References

1. NHS England. Changes to the GP contract in 2025/26. February 2025. https://www.england.nhs.uk/long-read/changes-to-the-gp-contract-in-2025-26/ [accessed 30/11/25]
2. NHS England. Digitally enabled triage. Version 2.2, 28 March 2025. https://www.england.nhs.uk/long-read/digitally-enabled-triage/ [accessed 30/11/25]

Featured photo by Miryam León on Unsplash.