This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Remote consultations by telephone or video have become common in primary care. Researchers assessed the safety of remote consultations (including NHS 111); they found 95 safety incidents across the UK between 2015 and 2023.
Researchers interviewed and observed GP staff, and made suggestions to improve the safety of remote consultations. They say it is important to give clear advice about what to do if symptoms do not improve, and suggest that remote consultations should not be offered:
- for some conditions (breathing problems, new psychosis, or acute chest or stomach pain, for example)
- when a parent is very concerned about a child
- when a condition has not resolved as expected or has worsened after a previous remote consultation
- to people who might struggle to understand or be understood (such as those with limited English or learning difficulties).
The team suggests ways to make remote consultations safer and more effective.
More information about remote consultations can be found on the NHS England website.
The issue: are remote consultations safe?
Remote consultations allow people to consult clinicians without leaving home. Providing remote clinical care and triage (determining the urgency of a condition) can help staff meet rising demand, and be convenient for patients.
Media stories have linked avoidable deaths and missed cancers with remote consultations. Researchers investigated safety incidents associated with remote consultations, and made suggestions about how to improve safety.
What’s new?
Safety incidents from remote primary care consultations are rare: 95 across the UK between 2015 and 2023. Researchers analysed these incidents via 100 formal interviews and numerous on-the-job interviews with practice staff, plus interviews with 10 GP trainers, 10 GP trainees, and 6 clinical safety experts (from Government, arm’s length bodies and health boards).
Safety incidents led to harm or serious risk of harm; examples included missed or delayed diagnoses, underestimation of severity or urgency and incorrect or delayed treatment. Serious harm was most often caused by a combination of inappropriate consultation type, poor relationship building, limited information gathering, limited physical assessment, wrong choice of clinical pathway and failure to consider social circumstances.
The researchers suggested that remote consultations are not appropriate:
- for conditions that require physical examination or tests (including breast lump, breathing difficulties, sudden chest or stomach pain)
- when conditions have not resolved as expected (including increased parental concern about a child)
- for people who might struggle with telephone or video communication (including those with limited English or learning difficulties, or people with multiple conditions and complex needs).
Practical suggestions for primary care could be to:
- use video calls instead of audio calls if a clinician has a hunch that the patient might be very unwell, and arrange for a physical examination if indicated
- provide effective safety-netting verbally and in writing (this could be through a text or email), including next steps for the patient if their condition worsens or doesn’t resolve as expected
- adopt organisation and system-level measures (adequate staffing, staff training and improved continuity of care for vulnerable people with complex needs).
Patients and carers could:
- think about how to clearly describe symptoms before the appointment, even if they have previously described them to a clinician
- consider having someone else present for the appointment to help them explain the problem
- ask what happens after the appointment and what to do if symptoms do not improve.
Why is this important?
These findings could improve patient safety and support clinicians in remote consultations. Staff could benefit from training on effective use of the telephone. Creative and flexible actions by staff (adapting standard procedures to take account of patients’ unique needs) can help reduce safety incidents, the researchers say.
The safety incidents analysed in this study included deaths and serious harm. The researchers had limited data on less serious incidents, which were less likely to be reported.
The findings do not directly compare the safety of different consultation types. It is not possible to say that a remote consultation caused harm, since in some cases a face-to-face consultation could have led to the same outcome.
What’s next?
Since the findings were published, the researchers have worked with members of the public to develop resources detailing the steps people can take to get the safest care. They have delivered national training sessions and produced guidance with NHS Resolution in England and GP education events in Northern Ireland. With research partner The Nuffield Trust, they have produced a policy brief which includes advice on making remote consultations safer. The researchers are working with the Royal College of General Practitioners Wales and Scotland to create resources for the parliaments of the devolved nations.
You may be interested to read
This is a summary of: Payne R, and others. Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis. BMJ Quality and Safety 2023;0:1–14.
A webinar summarising the findings of this study, as well as the broader project it was part of, Remote by Default 2.
An NIHR Evidence summary about safety-netting in primary care.
Information from the General Medical Council about when it is safe to prescribe during a remote consultation.
Information from the Royal College of General Practitioners for GPs about remote consultations.
A paper exploring the use of video consultations in urgent primary care settings: Payne RE, Clarke A. How and why are video consultations used in urgent primary care settings in the UK? A focus group study. British Journal of General Practice Open 2023; 7.
Funding: This study was funded by the NIHR Health and Social Care Delivery Research.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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