Research shows that requesting GP care by filling out a form online or on a smartphone instead of making an appointment with a GP can pose a risk to patient safety.
According to the Health Services Safety Investigations Body (HSSIB), GPs are not always specifically trained to provide online consultations. Patients who cannot access or navigate websites are also at risk.
The HSSIB study focused on consultations where the patient and physician were not in the same room and the patient did not receive a response in real time.
It said online tools can help GPs and patients by improving access and helping manage demand, but that there is evidence they have “contributed to a number of patient safety incidents”.
One example cited in the report is a patient whose cancer was diagnosed too late and who, as a result, required complex surgery.
The patient had visited their practice with a skin problem and was directed to an online form. After filling it out – and noting a history of skin cancer – the request was reviewed by administrative staff the next day.
The patient had a telephone consultation with the GP, who referred him to the dermatological service, but this was not an emergency.
However, while waiting, their symptoms worsened, suggesting a more advanced form of skin cancer. Their second online request contained no family history of skin cancer, and administrative staff assumed the patient was already under surveillance.
When he visited his GP two weeks later, the doctor suspected that the patient’s skin condition was a more aggressive form of cancer and referred him urgently.
The HSSIB investigation also found that there were limited reports of patient harm resulting from the use of online tools, which the HSSIB said was ‘contrary to what GPs, patients and academics had described’.
The report suggests that this ‘could possibly be due to a lack of recognition and reporting of incidents, as the use of online tools is still in its infancy in some practices and because GPs are ‘erring on the side of caution’ to ensure patient safety’.
The HSSIB warned that people who cannot access or use websites are also at risk.
It also emerged that GPs were not always well trained in online care. Novice GPs felt that they had not seen their patients in person enough to be able to provide remote care with confidence.
Nick Woodier, senior security researcher at the HSSIB, said: “We heard from patients and GP practices about their concerns about the security of online consultation tools.
“We listened to those concerns and investigated them and published this report.
“While the evidence of the harms that online tools can cause is limited at this time, there is an opportunity to proactively investigate and address the risks to patient safety as the use of these tools increases.”
The report states that the research “demonstrated first-hand the high demand for primary care and the ongoing efforts of those practices to deliver high-quality care”.
Figures published by NHS Digital last month showed that an estimated 30.8 million appointments were recorded through GP booking systems in May.
Approximately 19.8 million of these conversations took place face-to-face, 7.8 million by telephone, and 1.4 million online or via video.
Mr Woodier added: “GP practices are facing unprecedented demand and must ensure that patients can also access and receive care online.
“The future of healthcare includes technology to deliver care, but this must be done with recognition of potential risks to patient safety.”
Professor Kamila Hawthorne, Chair of the Royal College of GPs, said: “Delivering safe patient care is the highest priority for GPs and our teams, and it is important that the use of technological innovation in general practice supports us in this, not detracts from it.
“Many primary care practices have implemented online triage systems to ensure their patients receive timely and appropriate care for their healthcare needs.
“We know that some practices – and patients – think these work well, but this report clearly shows that others do not, and that could have very serious consequences.
“There is clearly a place for technology in healthcare, but when it is introduced it is essential that it is done safely and in a way that both helps patients access our care and services, and helps practices manage the increasing demand for it.”
Dr Rebecca Rosen, senior fellow at the Nuffield Trust, said: “The current arrangements for online consultations have been welcomed by many patients, but there is evidence they may deter others and expose some patients to clinical risk.
“Delivering 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 putting measures in place for those patients.”
An NHS spokesperson said: “Some patients may choose to have remote appointments if it is clinically appropriate and more convenient for them, but every GP practice should also offer face-to-face appointments if patients want or need them.
“Keeping patients safe is a priority for the NHS. Our online consultation methods have undergone extensive safety assessments and there are robust mechanisms in place to report and investigate in the extremely rare event of safety incidents.”
A Department of Health and Social Care spokesperson said: “Patients should be able to communicate with their GP in the way they choose, whether that is online or in person.
“That’s why we’re going to fix the front door of the NHS by bringing back the GP for those who want to see the same doctor regularly, as well as training thousands more GPs and cutting the bureaucracy that takes up their time.”
It comes after the General Medical Council (GMC) warned that plans to increase the number of doctors by creating more places in medical schools will fail unless support is given to trainers.
A GMC survey of over 52,000 junior doctors and over 22,000 doctors training them found that 29% of trainers struggled to utilise the time set aside for teaching people alongside their regular clinical duties.
Of the trainers who answered questions about burnout risk, more than half (52%) reported always or often feeling exhausted at the end of the workday.
A third (32%) said that their work frustrates them to a high or very high degree.
Professor Colin Melville, director of education at the GMC, said: “Plans to increase the number of places in medical schools are much needed and welcome.
“However, to ensure that these places produce the skilled doctors of tomorrow, we also need to increase the number of teachers and provide them with the necessary time and support.”