Online GP consultations have led to harm and death, investigation finds

Patients have died after describing their symptoms to a GP in an online form rather than at a face-to-face consultation, the NHS’s safety investigations body has revealed.

Online consultations with GP surgeries involve risks to patients’ safety and have led to sometimes serious harm and even death, an investigation by the Health Services Safety Investigations Branch (HSSIB) found.

The HSSIB’s 58-page report says that its investigation had “found a small number of reports to prevent deaths [by coroners] which referenced remote care, include online tools” but gave no details.

A coroner can issue a prevention of future deaths report if, after hearing the evidence presented at an inquest, they believe one or more public or private bodies – such as an NHS trust – should take specific steps to ensure that no more deaths occur in similar circumstances.

HSSIB highlighted a number of safety concerns posed by online forms, in which a patient outlines their symptoms which are later assessed by their GP surgery. Online consultation tools have led to people being misdiagnosed or their illness being missed altogether, care they need being delayed and patients being put off seeking a GP’s help at all, it said.

It voiced alarm at the fact that some GP surgeries insist that patients have to set out their symptoms in an online form as the first stage of the process of seeking care.

HSSIB highlighted one case in which a GP practice that operated that system did not realise that a patient had aggressive skin cancer. The patient submitted one form, in which they said they had a history of the disease, and were referred to a dermatology service.

But when they submitted a second form, making clear that their symptoms had got worse, administrative staff at the surgery “triaged the request as routine as they assumed the patient was already under follow-up”. They later underwent complex skin surgery for their cancer.

Another patient told HSSIB of their frustration that “it is very difficult to get a medical appointment now and my surgery is pushing more and more services online. It has got to the point where access is so difficult. I don’t seek advice and just hope minor conditions just go away.”

Healthwatch England, the patient champion, said it had also come across cases in which symptom information had been conveyed digitally and caused problems. It urged GP surgeries to keep offering face-to-face and telephone appointments and not rely solely on online contact.

“We have heard of examples of people’s E-consult queries going unanswered for days or not providing the options that covered their issues. As a result, people faced delays getting prescriptions or the care needed for ongoing or urgent problems,” said Louise Ansari, Healthwatch’s chief executive.

While some people like the fact that online consultation means they do not have to ring or visit their GP practice, others find digital-only communication “complicated and confusing”, she added.

Surgeries should “maintain traditional models of care alongside digital methods”, Ansari said.

Prof Kamila Hawthorne, the chair of the Royal College of GPs, said that many GP practices have begun using online triage systems to help speed up the care patients receive.

“We know that some practices – and patients – find these work well,” she said. “But it’s clear from this report that others don’t, and this can have very serious consequences.”