NHS England should evaluate patient safety risks associated with online consultation tools used by GPs, a report from the NHS safety investigation’s body has concluded.
It comes after an investigation which found the use of online consultation tools has led to harm and death in a small number of cases.
The Health Services Safety Investigations body report gave an example of a delayed skin cancer diagnosis in a patient with a history of the condition that had not been flagged in a second online request form and triaged as routine.
HSSIB found a ‘limited number of safety incidents’, including from prevention of future death reports from coroners. But it said there is likely to be underreporting.
Online tools were not always accessible and easy to use and did not always allow general practices to collect the necessary information they needed to make decisions, it found.
NHS England also needs to develop mechanisms for assuring that ICBs support GPs in implementing online tools, HSSIB recommended.
The report flagged that ICBs were frustrated that the Digital Pathways Framework had been ‘paused’ as it would ‘provide opportunities to better influence the design of software produced by developers’. They said that this ‘was preventing them from working to improve online consultation services in their regions’.
GPs had highlighted concerns to the investigators about the design of online tools, training needed to ensure consultations that used them were effective and the impact on workload.
The report, which talked to 16 practices and a patient focus group, found ‘limited evidence’ of GPs and patients being involved in the design process.
It also noted examples of the positive impact of use of online tools where general practice had transformed their ways of working.
Nick Woodier, senior safety investigator at HSSIB, 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.
‘We heard from patients and general practices about their safety concerns with online consultation tools.
He added: ‘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.’
Dr Rebecca Payne, a GP and NIHR in-practice fellow at the University of Oxford, who has done research with colleagues into the safety of online consulting tools and provided evidence to the investigation said such tools had been mandated for use by general practice at the national level but there had not necessarily been the support in place to help with implementation.
The report conclusion was very similar to their work which found serious harm was rare. They included a list of recommendations for practices to improve safety around online tools.
‘At the practice level, you need to make sure all your systems are configured to support requests coming in this way,’ Dr Payne said.
‘You also need to be aware that patients find creative ways to use online systems to get the outcome they want so sometimes inaccurate information can get put into the system.’
She added: ‘It is also about being aware that these systems don’t work for everybody and the CQC has said there should be other ways for patients to get through to practices.’
RCGP chair Professor Kamila Hawthorne 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 health care 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.
She added that GPs and their teams need adequate time to implement and learn to use new digital tools, and ongoing technical support for dealing with issues that may arise.
‘More widely, this just goes to show to the new Government how important it will be to invest properly in general practice infrastructure, including IT systems, and boost the GP workforce, so that we can provide safe, timely and accessible care for all our patients.’
An NHS England 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 version of this story was first published on our sister title Pulse.
