Patients are having diagnoses for cancer and other major conditions delayed because of “frustrating” online GP services which puts them off seeing a doctor, an investigation has found.
The Health Services Safety Investigations Body (HSSIB) said 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. 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 report concluded.
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 that 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.
Patients described feeling “frustrated”, “humiliated” and “embarrassed” when trying to use online tools, leaving them less likely to want to use them. They also described a loss of “trust” that their general practices could provide for their needs. They no longer felt they had a relationship with their practice or a specific GP, and worried about continuity in their care.
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 that 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 added that 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 said: “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.”
Nuffield Trust senior fellow Dr Rebecca Rosen welcomed the HSSIB’s findings. “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,” she said.
“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. Getting this right at pace is a challenge when all staff in general practice are already overloaded with work but it is essential if we are to make safe and effective use of digital technology in general practice.”
Officials pointed out the HSSIB’s report is only based on feedback from 16 practices and 34 patients, and that there are over three million online requests submitted per month by patients and carers.
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: “Patient safety is our top priority, and significant improvements are needed to restore public confidence in the health service. 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 to go to the same clinician regularly, as well as training thousands more GPs and cutting the red tape that ties up their time.”