Weighing up the risks: Remote GP consultations
Telephone and online GP appointments risk harming patients, according to a study published by the British Medical Journal (BMJ) in November 2023. The study found that remote consultations have been linked to an increase in fatalities due to serious health conditions, that would likely have been picked up at face-to-face appointments.
In the midst of the Covid-19 pandemic, GP practices changed how they provided care to patients. The Royal College of GPs reported that before the first lockdown in March 2020, approximately a quarter of GP appointments were carried out remotely (either by telephone or online).
Covid then shifted practices to reduce in person contact to protect staff and patients from the risk of infection. Although pandemic pressures have now eased, remote GP consultations remain a commonly used means of delivering care. Experts from Nuffield Trust and Oxford University examined 95 UK safety incidents within GP practices and Out of Hours settings between 2020 and 2023, such as settled compensation claims, reports and complaints.
Errors made over the phone included missed diagnoses and an underestimation of the severity of serious conditions including sepsis, cancer and congenital heart disease. It was concluded that such errors would not have been made if patients had been examined face-to-face. Further, the study identified an increased risk of patients coming to harm if they had urgent symptoms such as new abdominal or chest pain.
To address these risks, the study recommends that general practice staff carefully consider arranging face-to-face appointments for patients who have undergone initial remote consultations but are not showing signs of improvement. This approach can help ensure a more thorough examination and evaluation, reducing the likelihood of oversight or misinterpretation of symptoms. In addition, patients with pre-existing complex illnesses may benefit from face-to-face consultations, as these cases often require a comprehensive understanding of the patient's medical history and a detailed physical examination. Furthermore, it is suggested that clinicians may wish to consider refresher training on telephone and online consultations covering history taking, rapport building and safety netting.
There is potential for the types of risks identified in the study to translate into an increase in claims. This will be of considerable concern for Practices, practitioners and their insurers, particularly given the potential exposure to substantial damages given the nature of the conditions referred to in the study.
Insurers will want to satisfy themselves that Practices have robust protocols for remote consultations in place to identify, assess and manage risks, including those of misdiagnosis. For Practices and practitioners, implementing the recommendations made in the study will assist in mitigating the risks. In addition, clear and effective communication channels should be in place to facilitate the escalation of a patient's care as necessary to ensure that any concerns or the need for further intervention are promptly addressed and actioned.