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GP digital tools could cause patients harm, says report
Investigation by the Health Services Safety Investigations Body finds some online tools used in general practices could cause risk to patient safety and impact GP workload
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.”
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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.
NHS England must take action
While some were positive towards digital tools and the improvement they have made to their GP practice, some GPs felt it has added to their workload, particularly where online tools were used for asynchronous online consultations.
These were consultations that did not happen in real time, and where patients had to describe their symptoms in writing. GPs were concerned that patients may not provide all the information required, not disclose certain symptoms and problems, or give inaccurate information to get the outcome they desired.
“The result of the above was that some GPs were afraid of making wrong decisions on limited information,” the report said. “They therefore did not trust online tools for consultations and insisted on seeing or speaking to every patient to reduce the chance of missing or delaying a diagnosis.
“Some GPs also perceived that the changing model of general practice care with increased use of remote consultations had reduced their ability to manage ongoing/long-term problems and provide health advice. Care was felt to be less holistic (considering the whole patient) and more transactional (information exchange), particularly when a tool only allowed focus on a single medical problem.”
The HSSIB has called on NHS England to undertake an evaluation of the risks of patient safety of online consultation tools, and implement actions to support the safe delivery of care using online tools.
“HSSIB recommends that NHS England develops mechanisms for assuring that integrated care boards support general practices when implementing online consultation,” the report added. “This is to ensure online consultation tools are procured and implemented in ways that best support patient safety.”
The NHS is currently working on a Digital Pathways Framework for integrated care boards, however, the HSSIB said that during the time of writing the report, work on the framework has been paused.
