An official healthcare safety body has expressed concerns over patient safety in the increasing use of online consultation tools by GP practices.
The Health Services Safety Investigation Body (HSSIB) – an arm’s length body of the Department for Health and Social Care – has published a report on the tools saying they are not always accessible and easy to use, and do not always allow general practices to collect the necessary information they needto make decisions about a patient’s care.
It has carried out an investigation into the overall topic of the digital environment in primary and community care, during which patients and staff shared their concerns about safety incidents related to the online tools.
Some patients said they or people they knew were less likely to seek a consultation with general practice about a medical problem if they had to use an online tool, whether through choice or because they were unable to.
The report says: “HSSIB heard that patients are not always able to access and use online tools due to their personal circumstances, social exclusion or deprivation.”
Frustrated and embarrassed
During focus group discussions patients described feeling “frustrated”, “humiliated” and “embarrassed” when trying to use the tools, and described a loss of trust that their general practice could provide for their needs.
GP staff echoed these concerns, with some saying that online tools disadvantaged some patients, reduced continuity in patient care and had changed the value of consultations.
Staff across general practices visited by HSSIB gave examples of where the use of online tools had contributed to harm or had the potential to harm patients from missed or delayed care.
An example set out in the report was the case of delayed cancer diagnosis for a patient who was told by her general practice that they had to use an online tool to request a consultation with a healthcare professional. The patient had a more aggressive form of skin cancer than first thought and as a result the delay may have contributed to needing more complex surgery.
The report also points to an under-reporting of incidents, and that GPs highlighted concerns about the design of online tools, the potential impact on workload and the different skillset and training needed to ensure online consultations were effective. This reflects limited evidence of users (patients and staff) being involved in the design process.
Limited support
General practices also told the investigation they had limited oversight and support from their former clinical commissioning groups and current integrated care boards (ICBs) when procuring and implementing online consultation tools. This has contributed to variation in how tools have been implemented.
The report recognises, however, that the online consultation tools into general practice is part of the national vision for a “modern general practice model” and that there are examples of where they have produced a positive impact.
It also produces two recommendations for achieve improvements in safety: that NHS England undertakes an evaluation of the patient safety risks associated with the tools; and that it develops mechanisms for assuring that ICBs support general practices when implementing them.
It has also suggested actions that ICBs can take to improve patient safety, including involving general practices and patient groups as stakeholders in procurement processes for online consultation tools.
Opportunity to explore
Nick Woodier, senior safety investigator at HSSIB, said: “The future of healthcare includes technology to help deliver care, but this needs to be done with recognition of any potential risks to patient safety. We heard from patients and general practices about their safety concerns with online consultation tools.
“We listened and explored those concerns and have published this report. While evidence of harm related to online tools may currently be limited, there is an opportunity to proactively explore and address risks to patient safety as the use of these tools increases.”
