Patients reporting life-threatening conditions through online tools, GPs warn

Exclusive GPs have warned that new requirements around online requests risk compromising patient safety, with patients reporting breathing difficulties, severe vomiting, acute abdominal and chest pain, and rectal bleeding through online forms. 

A new Pulse and Management in Practice survey of 431 GPs and practice managers found that 67% are concerned for patient safety as a result of contractual changes brought in on 1 October that require practices to ensure online requests can be submitted between 8am to 6.30pm.

Several GPs responding to the survey also said that urgent requests involving unwell or feverish children had been submitted through the online tools.

And one GP said they had received an eConsult request from a patient at 6.25pm ‘stating that they are suicidal’.

GPs warned that currently there are inadequate safeguards against patients submitting urgent clinical requests through the online tools, and that burnout for GP practice staff caused by a surge in demand also presented a risk to patient safety. 

It comes after the BMA entered dispute with the Government over the changes, arguing that they are currently not safe to implement. Pulse exclusively revealed that the union had previously asked for the changes to be halted to address ‘significant concerns’ around patient safety.

However, the Government has repeatedly dismissed the concerns, with primary care minister Stephen Kinnock telling Pulse that he was confident necessary patient safeguards were in place ahead of the changes. 

Dr Caroline Delves, a GP partner in Norfolk, said her practice has received multiple serious clinical queries through administrative online forms since 1 October. 

She said: ‘Since the contract changes, we’ve had one six-week-old baby with a red lump that was growing on an admin form, and another five-week-old who was lethargic and vomiting.  

‘On Monday, I had a form through from a 35-year-old man on a non-urgent medical condition form saying he couldn’t breathe. When I rang him up, he really didn’t sound very well and he wasn’t able to swallow.’

The patient was able to go to A&E, but Dr Delves said he could conceivably have been waiting far longer to be signposted. 

She added: ‘That’s on a form that’s supposedly non-urgent – he could have sat there until we’d got through the other 70 forms we had to look at, which would have been unsafe.

‘We had someone on a Monday who disclosed they had been vomiting blood all weekend on a Monday morning via a change of address admin form.  

‘I think there’s probably a level of health literacy expectation in the policymakers that doesn’t exist for everybody on the ground.’

She added that her practice is having to look at all of the forms as the come in, which is ‘drawing staff away from doing the rest of the work of the practice’.  

Another GP said: ‘Patients have mentioned suicide and a colleague had an asthma attack patient contact after 5.30 pm. We did deal with both but they could have been waiting until the next day.’

GPs responding to the survey highlighted the risk of having a free text box option for patients to make online submissions, which is increasing the chance serious issues will be missed. 

One GP in the South East said: ‘I cannot believe how many patients are putting urgent clinical requests in the admin free text boxes.’

This included symptoms like severe vomiting and abdominal pain, pregnant with vomiting, and rectal bleeding. 

Removing free text boxes was one of the safeguards the BMA asked the Government to guarantee in a letter sent to primary care minister Stephen Kinnock last month.

The surge in demand following the changes has meant even practices well-versed in using online consultation tools said they were struggling to adjust. 

A GP in the North East said: ‘Despite having been total triage for over five years and using eConsult to do this, we have seen an increase in demand. While prior to 1 October our wait time was days, I suspect this will turn into weeks shortly if demand continues.’ 

Another survey respondent said the risk of burnout for GP practice staff caused by a surge in demand itself presented another risk to patient safety. 

The West Midlands GP said: ‘We’re doing 340 to 400 medical triages on a Monday, and other days, 200 to 300. It’s overwhelming and unsafe. Patients are dealt with quickly often through further symptom questionnaires (acute back pain, UTI, pill, cough etc) but it will burn us out.

‘By the time 5pm comes and admin needs to be done it’s hard to concentrate on the septic, suicidal or end of life patient that we try to prioritise between all the queries that are overwhelming us.’ 

Another GP in the North West said: ‘Processing online requests and triaging after a 12-13 hours intensive clinical day is unsafe and unsustainable.’

Surrey GP partner Dr Dave Triska told Pulse that notices asking patients not to submit urgent online requests is an insufficient safeguard. 

He said: ‘The counter argument that a lot of those would be trivial doesn’t really hold water, because it’s not a question of them being trivial or not. It’s that someone physically has to work their way through them to determine what is serious and what is not.  

‘Among that pile, you will have really serious health concerns that are flagging up, and won’t be able to work through them in a reasonable fashion or in a competent fashion, because you’ll be exhausted and making poor decisions.’ 

BMA GP committee England deputy chair Dr David Wrigley said: ‘It’s deeply worrying – and sadly unsurprising – that GPs are concerned for patient safety as a result of these contract changes.

‘We warned the government repeatedly in the past six months that allowing unlimited online consultation requests without the necessary safety measures or additional resources would overwhelm already stretched teams, divert doctors from face-to-face appointments, and risk urgent cases being missed.

‘General practice is not against the use of technology and have been embracing it for over 30 years, but innovation without safeguards is dangerous. We believe there is significant risk to patients and to our practice teams from this new initiative, and the Government must provide the protections it committed to back in February.’

Responding to the survey results, NHS England’s director for primary care Dr Amanda Doyle said: ‘It is right that patients should be able to contact their GP practice online – in addition to by phone and by walking in – which is why it was agreed by the BMA’s General Practice Committee in February.

‘In the many practices already offering this service, patient satisfaction is higher. Patient safety remains our priority and guidance and support has been provided to practices to help them put the necessary safeguards in place for urgent clinical requests.’

A Department of Health and Social Care spokesperson said: ‘In 2025 patients rightly expect to be able to contact their General Practice online – in fact, data shows that for the first time more patients are contacting their practice online than over the phone. The majority of practices have rolled out this service successfully and we are supporting others to increase compliance.

‘Patients submitting online requests for urgent issues should be told to phone their GP or attend in person. It is standard practice for GPs to direct patients to other services when that would better serve the urgency of their need. This is part of how the NHS system is designed to work efficiently and ensure patients get the right level of care.

‘In just one year, we’ve delivered millions of additional appointments to patients who need them, recruited more than 2,500 GPs across the country and provided an extra £1.1 billion of vital funding as we reverse more than a decade of neglect in our General Practice services.’