Virtual GP appointments online or over the phone could leave patients ‘at risk’, new research has found.
Researchers said that while mistakes via remote consultations are rare, there is a risk patients will be under-diagnosed. They said GPs are being swayed by what has been said previously, and less qualified staff are not acting on signs of illness.
The study, published in BMJ Quality and Safety, looked at 95 UK safety incidents between 2020 and 2023 – including during the pandemic – such as complaints, compensation and reports. Interviews with surgeries were also included.
Some errors related to serious conditions such as congenital heart disease, pulmonary oedema, sepsis, cancer and diabetic foot complications “which would likely have been readily diagnosed with an in-person examination”, the study said.
In some cases, GPs themselves realised the limitations of remote consultations. One GP said: “I’ve remembered one father that called up. Really didn’t seem to be too concerned.
“And was very much under-playing it and then when I did a video call, you know this child… had intercostal recession… looked really, really poorly. And it was quite scary actually that, you know, you’d had the conversation and if you’d just listened to what dad was saying, actually, you probably wouldn’t be concerned.’”
The study found that patients with pre-existing conditions (and especially if they had several or they were getting worse), and the very young and the elderly “were particularly difficult to assess by telephone”. Researchers said: “Clinical conditions difficult to assess remotely included possible cardiac pain, acute abdomen, breathing difficulties, vague and generalised symptoms and symptoms which progressed despite treatment.”
The study pointed to “poor rapport building” as an issue when assessing patients, alongside “inadequate information gathering, limited clinical assessment”, patients signposted down the wrong path and “inadequate attention to social circumstances”.
Researchers found that GP surgeries were suffering due to understaffing and high demand. Ways of training patients and pathways for care were found to be “complex, multi-layered and hard to navigate; some involved distributed work among multiple clinical and non-clinical staff.
The study recommended clinicians ensure the patient knows what the next steps are in their care, while patients should make clear if they are deteriorating. Professor Greenhalgh, chief investigator from the University of Oxford, said: “The vast majority of remote clinical consultations in general practice are safe, in large part because staff are alert and err on the side of caution.
“When safety incidents happen, organisational pressures and poor communication often play a major role. This new research has identified more precisely where the risks lie and what measures we can take to reduce risks further.”
Dr Rebecca Rosen, study author from the Nuffield Trust, said: “Remote consulting is here to stay and the study has identified ways in which to ensure quality and safety.
“Every clinician must be aware of high-risk symptoms for which it’s safer to see patients face to face; must listen and respond carefully to patients who say they need an in-person appointment and should consult face-to-face if a patient has not improved after previous remote consultations.
“We can also ensure that patients have the knowledge and tools to help them to get the best out of their consultations.”
Latest data for England shows 71% of GP consultations are face-to-face while 24% are over the phone.
