Calendar An icon of a desk calendar. Cancel An icon of a circle with a diagonal line across. Caret An icon of a block arrow pointing to the right. Email An icon of a paper envelope. Facebook An icon of the Facebook "f" mark. Google An icon of the Google "G" mark. Linked In An icon of the Linked In "in" mark. Logout An icon representing logout. Profile An icon that resembles human head and shoulders. Telephone An icon of a traditional telephone receiver. Tick An icon of a tick mark. Is Public An icon of a human eye and eyelashes. Is Not Public An icon of a human eye and eyelashes with a diagonal line through it. Pause Icon A two-lined pause icon for stopping interactions. Quote Mark A opening quote mark. Quote Mark A closing quote mark. Arrow An icon of an arrow. Folder An icon of a paper folder. Breaking An icon of an exclamation mark on a circular background. Camera An icon of a digital camera. Caret An icon of a caret arrow. Clock An icon of a clock face. Close An icon of the an X shape. Close Icon An icon used to represent where to interact to collapse or dismiss a component Comment An icon of a speech bubble. Comments An icon of a speech bubble, denoting user comments. Comments An icon of a speech bubble, denoting user comments. Ellipsis An icon of 3 horizontal dots. Envelope An icon of a paper envelope. Facebook An icon of a facebook f logo. Camera An icon of a digital camera. Home An icon of a house. Instagram An icon of the Instagram logo. LinkedIn An icon of the LinkedIn logo. Magnifying Glass An icon of a magnifying glass. Search Icon A magnifying glass icon that is used to represent the function of searching. Menu An icon of 3 horizontal lines. Hamburger Menu Icon An icon used to represent a collapsed menu. Next An icon of an arrow pointing to the right. Notice An explanation mark centred inside a circle. Previous An icon of an arrow pointing to the left. Rating An icon of a star. Tag An icon of a tag. Twitter An icon of the Twitter logo. Video Camera An icon of a video camera shape. Speech Bubble Icon A icon displaying a speech bubble WhatsApp An icon of the WhatsApp logo. Information An icon of an information logo. Plus A mathematical 'plus' symbol. Duration An icon indicating Time. Success Tick An icon of a green tick. Success Tick Timeout An icon of a greyed out success tick. Loading Spinner An icon of a loading spinner. Facebook Messenger An icon of the facebook messenger app logo. Facebook An icon of a facebook f logo. Facebook Messenger An icon of the Twitter app logo. LinkedIn An icon of the LinkedIn logo. WhatsApp Messenger An icon of the Whatsapp messenger app logo. Email An icon of an mail envelope. Copy link A decentered black square over a white square.

GP appointments over the phone or online can ‘put patients at risk’

A GP at their desk (Anthony Devlin/PA)
A GP at their desk (Anthony Devlin/PA)

GP appointments over the phone or online can miss serious illnesses and put patients at risk, according to a new study.

Researchers said mistakes via remote consultation are rare, but there is a risk of patients being under-diagnosed, GPs being swayed by what has been said previously, and less qualified staff not acting on signs of illness.

The study, published in BMJ Quality and Safety, looked at data from 95 UK safety incidents between 2020 and 2023 (including from during the pandemic), such as complaints, settled compensation claims and reports. Interviews with practice staff were also included.

Some of the errors made related to serious conditions such as congenital heart disease, pulmonary oedema, sepsis, cancer and diabetic foot complications “which would likely have been readily diagnosed with an in-person examination”, the study said.

It added: “Several safety incidents involved clinicians assuming that a diagnosis made on a remote consultation was definitive rather than provisional.

“Especially when subsequent consultations were remote, such errors
could become ingrained, leading to diagnostic over-shadowing and missed or delayed diagnosis.”

In one case, a woman in her 70s experiencing sudden breathlessness was told by a GP receptionist she would be called back but this never happened as the receptionist became distracted by a patient in the waiting room. The telephone patient deteriorated and died at home that afternoon.

In another case, NHS 111 staff failed to diagnose a pregnant woman with premature rupture of membranes and instead she was taken down a “urinary problems algorithm”.

Elsewhere, a 16-year-old girl also died of sepsis after a GP spoke to her older sister on the phone and mistakenly diagnosed glandular fever.

Other cases involved missed pulmonary embolism in a new mother leading to her death and missed congenital heart disease in a baby.

Mental health survey
A registration form and a stethoscope (Anthony Devlin/PA)

In some cases, GPs themselves realised the limitations of remote consultations.

One GP said: “I’ve remembered one father that called up. Really didn’t seem to be too concerned.

“And was very much under-playing it and then when I did a video call, you know this child… had intercostal recession… looked really, really poorly. And it was quite scary actually that, you know, you’d had the conversation and if you’d just listened to what dad was saying, actually, you probably wouldn’t be concerned.’”

The study found that patients with pre-existing conditions (and especially if they had several or they were getting worse), and the very young and the elderly “were particularly difficult to assess by telephone”.

Researchers said: “Clinical conditions difficult to assess remotely included possible cardiac pain, acute abdomen, breathing difficulties, vague and generalised symptoms and symptoms which progressed despite treatment.”

The study pointed to “poor rapport building” as an issue when assessing patients, alongside “inadequate information gathering, limited clinical assessment”, patients signposted down the wrong path and “inadequate attention to social circumstances”.

Researchers found that GP surgeries were suffering due to understaffing and high demand.

Ways of training patients and pathways for care were found to be “complex, multi-layered and hard to navigate; some involved distributed work among multiple clinical and non-clinical staff.

The study recommended clinicians ensure the patient knows what the next steps are in their care, while patients should make clear if they are deteriorating.

Professor Greenhalgh, chief investigator from the University of Oxford, said: “The vast majority of remote clinical consultations in general practice are safe, in large part because staff are alert and err on the side of caution.

“When safety incidents happen, organisational pressures and poor communication often play a major role.

“This new research has identified more precisely where the risks lie and what measures we can take to reduce risks further.”

Dr Rebecca Rosen, study author from the Nuffield Trust, said: “Remote consulting is here to stay and the study has identified ways in which to ensure quality and safety.

“Every clinician must be aware of high-risk symptoms for which it’s safer to see patients face to face; 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.”

Latest data for England shows 71% of GP consultations are face-to-face while 24% are over the phone.

Dr Victoria Tzortziou-Brown, vice chair of the Royal College of GPs, said a lot of high quality, safe care is delivered remotely in general practice on a daily basis, “as this research makes clear”.

She added: “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.”