---

Health Services Safety Investigations Body has published a report including evidence that the use of virtual GP services has brought benefits, but also contributed to the compromise of patient safety

---

A government healthcare watchdog has called on NHS England to assess the risks to patient safety that have been created by the use of online GP consultations.

The recommendation, made by the Health Services Safety Investigations Body (HSSIB), comes following a major research exercise conducted by the organisation that found evidence of virtual doctors’ appointments having compromised patient safety.

The assessment of virtual health systems and their impact was launched because, “as digital-based approaches to healthcare are increasingly implemented… a proactive approach to identifying risks to patient safety must be undertaken”, the report said.

The research concluded that, “although there is evidence these tools have benefits, the investigation also found evidence that they had contributed to some patient safety incidents”.

HSSIB, which operates as an arm’s-length body of the Department of Health and Social Care, also found that “where actual and potential harm to patients has been contributed to by the use of online consultation tools, these incidents are not always reported”.

Harms that might be suffered by patients as a result of the use of technology include instances “where they are unable to use an online consultation tool due to their personal circumstances”, as well as “inequitable access to care if patients are not aware of or unable to use other access routes”.

The investigation also found that “the design and configuration of an online consultation tool may mean it is not always able to safely deliver the tasks it is being used for, nor address and meet the needs of its users, [including] patients, carers and staff”.

HSSIB noted that GPs have not always had training tailored specifically to conducting consultations remotely. Some doctors reported “concerns about the making of decisions based on the limited clinical information provided through an online tool”.

Many surgeries also “have had limited oversight” from their local integrated care board – formerly clinical commissioning groups – during the process of procurement and implementation of an online consultation tool. The array of pressures facing GPs “makes it difficult for some practices to allocate the necessary time and resources to ensure implementation is successful”.

The report added: “NHS regions and general practices may not know their local population’s digital needs and capabilities. Assumptions about the needs of patient populations may be made as a result.”

---

Related content

• NHS delays £350m GP IT framework after legal challenge
• NHS Digital cites transformation ‘turning point’ after £750m investment in FY22
• New owner of remote NHS GP service pledges no disruption or staff cuts after Babylon bankruptcy

---

Another issue identified in the report was “limited patient engagement and education” which, in some cases, can result in misunderstandings about how and where care can be accessed.

“The investigation found examples in different parts of the country where patients believed they could no longer access general practice care if they could not use the online route,” the report said.

It added: “Some general practices are having to limit the number of daily requests available via their online consultation tools to protect patient safety. There are further concerns that tools may increase future demand by reducing opportunities to provide health promotion advice or manage long-term health conditions.”

Risks and recommendations
In light of all these challenges, HSSIB makes two safety recommendations.

The first of these is a request that “NHS England undertakes an evaluation of the risks to patient safety of online consultation tools in general practice… [and] identify and implement actions to support the safe delivery of care using online consultation tools in line with best practice”. This evaluation should call on the findings of the HSSIB report as well as other research and first-hand evidence from surgeries.

The watchdog also “recommends that NHS England develops mechanisms for assuring that integrated care boards support general practices when implementing online consultation”. Such mechanisms should cover the buying and deployment of remote care systems.

In addition to these recommendations, the report adds four formal “safety observations”, beginning with the finding that the NHS could do more at a national level by way of “supporting general practices to report patient safety incidents associated with the use of online consultation tools”.

HSSIB also observes that national bodies could better cultivate the “conditions within which online consultation tools can be effectively implemented, including ensuring general practice has the resources, capacity and capabilities to meet the needs of its patients”.

The penultimate observation notes that central NHS entities should promote a more holistic approach by examining “how long-term condition management and proactive health promotion can be accomplished alongside the online consultation model”.

The report finally observes patient safety could be improved if national organisations worked more closely with “software developers of online consultation tools to meaningfully involve patients and staff in software design to help better understand their needs”.

In addition to these recommendations and observations, HSSIB outlines a “safety response” it encourages to be pursued by Integrated Care Boards (ICBs) –  the 42 bodies that were created in 2022 to oversee the provision of a comprehensive range of services delivered in their area, by NHS, local authority, voluntary organisations, and other care providers. The boards replaced clinical commissioning groups.

HSSIB finds that ICBs could better support the safety of patients in three ways: “involving general practices and patient groups as stakeholders in procurement processes for online consultation tools; supporting general practices to implement tools in a way that meets the specific needs of a practice and its patients; [and] ensuring general practices provide suitable alternatives to online consultation tools where they are needed for patients to access and receive care”.

The investigatory body gathered its findings for the report via engagement with representatives from a range of general practices, as well as ICBS, primary care networks, and local medical committees. Investigators also conducted focus group exercises with patients.

The watchdog said that its findings are “intended for healthcare policy makers to help influence improvements in patient safety, [and also] for those who work in and engage with general practice” – including all the types of bodies whose evidence informed the report.

The publication of the document comes less than a year after Babylon Health – the firm whose technology underpins GP at Hand, a virtual NHS surgery with over 100,000 patients, making it the largest practice in the country – went into administration.