Remote GP consultations carry more risk for patients with some urgent conditions

Remote GP consultations carry more risk for some patients with certain urgent conditions, according to new research.

The study found that while safety incidents are extremely rare in remote primary care, deaths and serious harms can happen.

In response to the study’s findings, the authors say GPs should strongly consider face-to-face consultations for patients who have had an initial remote consultation who are not improving, and patients with pre-existing complex illness.

Remote GP consultations still common practice

The switch to remote consultations happened largely as a result of the Covid-19 pandemic, and while more patients are now being seen face to face, telephone and online consultations remain common practice in many health settings.

The Remote by Default study, published in BMJ Quality and Safety, aimed to understand why safety incidents occur in remote encounters and how to prevent them.

Researchers assessed 95 safety incidents involved remote interactions and identified when remote consultations were safe to use. The findings revealed that remote consultations are more risky for patients who:

• Are very old or very young
• Live in care settings
• Have communication challenges (such as deafness or a learning disability)
• Struggle to understand the health system
• Lack technology such as a smartphone or a computer.

They also carry higher risk for patients with certain urgent conditions, such as new chest or abdominal pain, palliative care, physical injuries or diabetes.

Safety risks include missed or inaccurate diagnoses, under-estimation of severity, delayed referral and treatment and inadequate follow-up.

Improving the quality and safety of remote GP consultations

The authors of the study say training is now needed for staff so they are able to identify safety risks and how they can be mitigated.

Professor Trish Greenhalgh, Dr Rebecca Payne and a research team from the Universities of Oxford and Plymouth and the Nuffield Trust also make various recommendations on how to improve quality and safety of remote consultations. This includes:

• Establishing protocols in GP practices so that clinical and nonclinical staff can escalate a patient’s care when needed.
• Ensuring staff are communicating effectively, putting the patient at ease and establishing a good rapport, as this can contribute to more accurate assessment.
• Informing patients of the next steps in their care and who to contact if things go to plan. Verbal advice should be backed up with a text or an email.
• Ensuring patients do not get lost in the system and that their care is followed up.
• Advising patients to inform their GP of all the key points of their condition, even if they have told another member of the team.
• Teaching patients that they can ask for an in-person appointment if they have already had two remote appointments for a condition that isn’t improving, and they can request written information via text or email if they need it.

Providing patients with the tools they need to get the most out of consultations

Chief investigator of the study Professor Greenhalgh says while the vast majority of remote clinical consultations are safe, this research has identified “more precisely where the risks lie and what measures we can take to reduce risks further.”

Dr Rebecca Rosen from the Nuffield Trust is now urging GPs and other primary care staff to take note of the findings and be aware of the high-risk symptoms for which it’s safer to see patients face to face.

“[Clinicians] must listen and respond carefully to patients who say they need an in-person appointment and should consult face to face if a patient has not improved after previous remote consultations.

“We can also ensure that patients have the knowledge and tools to help them to get the best out of their consultations,” she said.