Online access changes risk disadvantaging non-English speakers, GP leaders warn

Mandatory contract changes requiring GP practices to keep their online consultation tools open regardless of capacity risk disadvantaging non-English speakers who are trying to access care, GP leaders have warned.

In a briefing organised this week by campaigning group Rebuild General Practice and chaired by Pulse editor-in-chief Jaimie Kaffash, GPs leaders raised concerns over the accessibility of the online consultation tools.

It follows contractual changes which came into force on 1 October, requiring GP practices to keep their online tools open between 8am to 6.30pm for routine and admin requests.

Londonwide LMCs chief executive Dr Lisa Harrod-Rothwell argued that the increased focus on online access risks disadvantaging non-English speakers who are trying to access care.

During the briefing, she cited one instance where she received an online form completed in Chinese. ‘Trying to pull out red flags [in a form] that’s filled in in Chinese is quite difficult,’ she said.

Dr Harrod-Rothwell said that existing issues around the misuse of forms, such as reports of severe clinical requests being filed as administrative requests via online forms, are particularly impacting non-English speakers, and added that online forms don’t ‘work for everybody’.

She said: ‘Sometimes you have something that’s been classified as admin, like a request for paperwork, and actually it’s a really serious, urgent request, because people either haven’t been able to read, haven’t been able to understand or haven’t been able to answer [the form].’

Pulse exclusively revealed that since the requirements came into force, GP practices have been accused of excluding older patients due to implementing the changes.

And GPs have previously warned that the requirements risk compromising patient safety – with patients reporting breathing difficulties, severe vomiting, acute abdominal and chest pain, and rectal bleeding through online forms. 

Dr Harrod-Rothwell also said that online forms can miss important context that is usually present in face-to-face appointments. She added: ‘Taking a history is something we take years to learn and to narrow down – you can’t get that through filling in a form, and it’s more complex than just buried red flags.’

GP leaders attending the briefing also said that under the new requirements practices have been seeing fewer people face-to-face, due to having to constantly monitor online requests.

According to Dr Jessica Harvey, a GP partner at Wenlock and Cressage, access has actually worsened at her practice, from a 24-48 hour turnaround on eConsults to now 72 hours, ‘if we’re lucky’.

Gateshead LMC chair Dr Paul Evans told the briefing: ‘Now the on-call doctor each afternoon has had all the face-to-face patients taken off them, just to stay on top of the excess work that is coming in, just to filter out the dangerous from the innocuous.’

Some GP practices have already considered cutting their lists as they work beyond capacity to meet ever-increasing demand.

Dr Evans said: ‘We have essentially had our doors forced open wide, at the expense of continuity, at the expense of quality, at the expense of safety.’

Dr Mohit Mandiratta, a GP partner and trainer from the West Midlands, told the briefing that under the new system, ‘everything turns into an urgent on-the-day query’, and that GPs ‘can’t do all the other things we need to’.

He said: ‘If we are just dealing with access, we can’t do the continuity of care, which all sorts of studies will tell you is the best kind of care. It improves health outcomes. It reduces hospital admissions. We can’t do that if we’re just dealing with access.’

The BMA is currently in dispute with the Government over the changes and LMC leaders have recently voted in favour of refusing to comply with the requirements in protest.