GP digital tools could cause patients harm, says report

Patient safety incidents related to the use of digital tools in GP practices go underreported, according to a report by the Health Services Safety Investigations Body (HSSIB).

The HSSIB, which is an arms-length body of the Department for Health and Social Care (DHSC) has been investigating the safety of online consultation tools in general practice, highlighting risks to patient safety.

The investigation, which was launched due to concerns raised by patients and staff, comes as the NHS is rapidly increasing its use of online consultation tools, with the new GP contract making it a contractual requirement for GPs to offer and promote one.

However, HSSIB found the risk to patient safety these tools bring are not well understood, and safety incidents involving patients and staff often go unreported.

The report found limited serious incidents that had been reported, and while researchers described how safety incidents are rare, they also said that safety-related evidence on remote and online consultations is inadequate.

“The investigation’s finding of limited reports of patient harm contributed to by the use of online tools conflicted with what general practitioners, patients and academics had described to the investigation,” the report said. “That conflict was heard to 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 added that reporting of safety incidents in general practices is known to be lower than in other healthcare settings. “Staff across the general practices visited by the investigation gave examples of where their use of online tools had contributed to harm or had the potential to harm patients,” the report said. “They also acknowledged that these examples were not always reported as incidents.”

The HSSIB also ran patient focus groups as part of its investigation, and found that patients themselves also shared concerns about the use of online tools and potential harm. Patients told the investigation they were less likely to seek a consultation if they had to use online tools, either because they did not want to, or because they were unable to.

Some patients added that their GPs insisted on them using online tools, which led to patients feeling frustrated, humiliated and embarrassed.

“This meant they had to use the online tool, get someone else to help them use the tool, seek other routes to receive care such as by going to an emergency department, or they went without care,” the report said.

“For several patients engaged with, the increasing use of online tools to access care and for consultation led them to believe they could no longer have telephone or face-to-face consultations. These beliefs, coupled with difficulties using online tools, meant some had not sought medical advice when they needed it.”

Some tools were also not always accessible, meaning that they created a barrier to some patients seeking help, which in itself created a risk of harm.