Patients have died after describing their symptoms to a GP online rather than during a face-to-face consultation, the NHS safety body has revealed.
Research by the Health Services Safety Investigations Branch (HSSIB) has found that online consultations at GP surgeries pose risks to patient safety and have sometimes led to serious harm and even death.
The 58-page HSSIB report said the investigation “found a small number of reports to prevent deaths (by coroners) that referred to remote care, including online tools”, but did not provide details.
A coroner can report on the prevention of future deaths if, after hearing the evidence presented at an inquest, they consider that one or more public or private bodies – such as an NHS trust – should take specific steps to ensure that further deaths do not occur in similar circumstances.
HSSIB highlighted a number of safety issues with online forms, in which a patient describes their symptoms that are later reviewed by their GP. Online consultation tools have led to people being misdiagnosed or having their conditions missed altogether, delaying the care they needed and preventing patients from seeking help from a GP altogether, the report said.
There have been complaints that some GP practices require patients to enter their symptoms online as the first step in the process of seeking help.
HSSIB highlighted a case where a GP practice using that system failed to recognise that a patient had aggressive skin cancer. The patient filled out a form stating a history of the disease and was referred to a dermatology service.
But when they submitted a second form, stating that their symptoms had worsened, the clinic’s administrative staff considered the request routine, assuming the patient was already under control. They later underwent complex skin surgery for their cancer.
Another patient told HSSIB of his frustration that “it is now very difficult to get a medical appointment and my practice is pushing more and more services online. It has gotten to the point where access is so difficult. I don’t seek advice and just hope minor ailments will just go away.”
Healthwatch England, the patient advocate, said it had also come across cases where symptom information had been transferred digitally and was causing problems. It urged GP practices to continue offering face-to-face and telephone appointments and not rely solely on online contact.
“We’ve heard examples of people having their e-consultation questions go unanswered for days, or not being offered the options that covered their concerns. As a result, people have experienced delays in getting prescriptions or the care they need for ongoing or urgent problems,” said Louise Ansari, CEO of Healthwatch.
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While some people appreciate the fact that online consultations mean they don’t have to call or visit their GP, others find communicating via digital means alone “complicated and confusing”, she added.
According to Ansari, practices must “maintain traditional care models alongside digital methods.”
Many GP practices have started using online triage systems to speed up the care patients receive, according to Prof Kamila Hawthorne, Chair of the Royal College of GPs.
“We know that some practices – and patients – think these work well,” she said. “But this report clearly shows that others don’t, and that can have very serious consequences.”