Accessing GP services online could pose risk to patient safety, probe finds

Accessing GP services by filling in a form online or on a smartphone, rather than having a face-to-face appointment with a family doctor, could pose a risk to patient safety, according to an investigation.

GPs are not always specifically trained to do online consultations, while patients who cannot access or navigate websites are also at risk of harm, the Health Services Safety Investigations Body (HSSIB) said.

The probe by the HSSIB focused on consultations where the patient and doctor were not in the same room and the patient did not receive a response in real time.

It said while online tools can benefit GPs and patients by improving access and helping to manage demand, there was evidence that they “had contributed to some patient safety incidents”.

One example used in the report was a patient whose cancer diagnosis was delayed and as a result needed complex surgery.

The patient had visited their practice with a skin problem and was signposted to an online form. After completing it – and noting a history of skin cancer – the request was triaged by administrative staff the next day.

The patient had a phone consultation with the GP, who made a non-urgent referral to dermatology services.

However, while waiting, their symptoms worsened, suggesting a more advanced form of skin cancer. Their second online request did not include the family history of skin cancer and administrative staff assumed the patient was already under a follow-up.

At a GP appointment two weeks later, the doctor suspected the patient’s skin condition was a more aggressive cancer and made an urgent referral.

The HSSIB investigation also found there were limited reports of patient harm associated with the use of online tools, which it said “conflicted with what GPs, patients and academics had described”.

It said this could “potentially be due to a lack of recognition and reporting of incidents, because the use of online tools in some practices was still in its infancy, and because GPs will ‘err on the side of caution’ to maintain patient safety”.

The HSSIB warned people who cannot use or access websites could also be at risk of harm.

It also found GPs were not always properly trained in online care, with newer family doctors feeling they had not seen enough patients face to face to confidently provide care remotely.

Nick Woodier, senior safety investigator at the HSSIB, said: “We heard from patients and general practices about their safety concerns with online consultation tools.

“We listened and explored those concerns and have published this report.

“While evidence of harm related to online tools may currently be limited, there is an opportunity to proactively explore and address risks to patient safety as the use of these tools increases.”

The report said the probe “saw first-hand the high demand for general practice services and the ongoing efforts of those practices to deliver high-quality care”.

Figures published by NHS Digital last month show there were an estimated 30.8 million appointments recorded by GP booking systems in May.

Of these, about 19.8 million were carried out face to face, with 7.8 million over the telephone and 1.4 million either online or via video.

Mr Woodier added: “General practices are facing unprecedented demand and are being asked to ensure patients also have an online option to access and receive care.

“The future of healthcare includes technology to help deliver care but this needs to be done with recognition of any potential risks to patient safety.”

Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said: “Delivering safe patient care is the number one priority for GPs and our teams, and it’s important that the use of any technological innovation in general practice supports us in this, and doesn’t detract from it.

“Many GP practices will have introduced online triage systems in order to ensure their patients receive timely and appropriate care for their healthcare needs.

“We know that some practices – and patients – find these work well but it’s clear from this report that others don’t, and this can have very serious consequences.

“There is clearly a place for technology in healthcare but when it is introduced it is essential it is done so safely and in a way that both helps patients to access our care and services, and helps practices manage the escalating demand for them.”

Nuffield Trust senior fellow Dr Rebecca Rosen said: “The current arrangements for online consultations have been welcomed by many patients but there is evidence they can deter others and put some patients at clinical risk.

“Providing online consultations safely and to a high standard requires careful design and implementation by practices and a clear focus on identifying which patients may struggle with remote and online consultations and put in place mitigations for those.”

An NHS spokesperson said: “Some patients choose remote appointments where it is clinically appropriate and more convenient for them, but every GP practice must also offer face-to-face appointments where patients want or need them.

“Keeping patients safe is a priority for the NHS. Our online consultation methods have been through extensive safety assessments, and there are robust mechanisms in place to report and investigate in the extremely rare case of safety incidents.”

A Department of Health and Social Care spokesperson said: “Patients should be able to interact with their GP in the manner they choose, whether that’s online or in person.

“That’s why we’re going to fix the front door of the NHS by bringing back the family doctor for those who want the same clinician regularly, as well as training thousands more GPs and cutting the red tape that ties up their time.”

It comes as the General Medical Council (GMC) warned plans to boost the number of doctors by creating more medical school places will fail unless trainers are supported.

The GMC’s poll of more than 52,000 doctors in training and more than 22,000 doctors who train them found that 29% of trainers struggled to use the time allocated for teaching people alongside regular clinical work.

Of trainers who answered questions on the risk of burnout, more than half (52%) said they always or often felt worn out at the end of the working day.

A third (32%) said their work frustrates them to a high or very high degree.

Professor Colin Melville, director of education at the GMC, said: “Plans to increase medical school places are much needed and welcomed.

“However, to ensure these places produce the skilled doctors of tomorrow, we also need to increase the number of educators and provide them with the necessary time and support.”