Serious harm associated with remote GP consultations is ‘extremely rare’, study finds

Serious harm to patients associated with remote GP consultations is ‘extremely rare’, a new study has found.

The research led by the University of Oxford found only 95 safety incidents involving remote interactions ‘despite an extensive search’ going back to 2020, which included looking through complaints submitted to the NHS in England, settled indemnity claims and reports.

Separately, it studied 12 GP practices across the UK to learn why safety incidents occur in relation to remote consultations and how to prevent them.

The authors said that safety incidents ‘involving death or serious harm’ were ‘rare’, but those that occurred were characterised by a combination of:

• inappropriate choice of modality
• poor rapport building
• inadequate information gathering
• limited clinical assessment
• inappropriate clinical pathway
• failure to take account of social circumstances.

They pointed out that during the pandemic remote triage and consultations were occurring in the context of ‘understaffing’ and ‘high demand’.

The study also gave recommendations to reduce safety incidents in remote primary care, including clinical conditions and clinical trajectories ‘for which an in-person assessment is often required’ (see box below).

The report said: ‘An important overall finding from this study is that examples of deaths or serious harms associated with remote encounters in primary care were extremely rare, amounting to fewer than 100 despite an extensive search going back several years.

‘Remote triage and consultations expanded rapidly in the context of the COVID-19 crisis; they were occurring in the context of resource constraints, understaffing and high demand.

‘Triage and care pathways were complex, multilayered and hard to navigate; some involved distributed work among multiple clinical and non-clinical staff.

‘In some cases, multiple remote encounters preceded (and delayed) a needed in-person assessment.’

RCGP vice chair Dr Victoria Tzortziou-Brown said that the study makes it clear that a lot of safe care is delivered remotely in general practice on a daily basis.

She said: ‘It is important that GPs and our teams are able to offer patients access to our services in a variety of ways, and whilst many patients prefer to see their GP face to face, many appreciate the convenience that remote consulting offers.

‘The college’s position is that the method of consulting should be a shared decision between clinician and patient based on clinical need, and clearly remote consultations will be more appropriate for some patients than others.’

She added that while there is risk associated with all medical consultations, delivering remote care ‘comes with specific challenges and limitations’.

She said: ‘[This research] makes a number of helpful recommendations in terms of identifying patients for whom remote care may not be appropriate and to support GP teams to ensure remote consultations are delivered as safely as possible.

‘GPs and our teams are working under intense workload and workforce pressures which create challenges giving patients the care they need.’

Earlier this year, a study found that remote GP consultations can be as effective as face-to-face appointments when it comes to some conditions, including mental illness, alcohol misuse, weight management and stop smoking advice.

Last year, researchers recommended that reviewing the audio of recorded remote GP consultations should be used routinely as a way to assess quality of care.