HSSIB investigation report - Workforce and patient safety: digital tools for online consultation in general practice (25 July 2024)

Summary

This investigation by the Health Services Safety Investigations Body (HSSIB) explores the patient safety risks associated with the use of online consultation tools in general practice. The investigation focussed on the use of these tools for ‘asynchronous’ consultation where the patient and healthcare professional are not in the same room, and the patient does not receive a response in real time.

Content

Findings of this report included:

• Where actual and potential harm to patients has been contributed to by the use of online consultation tools, these incidents are not always reported. There is underreporting of patient safety incidents in general practice.
• Harm can result to patients where they are unable to use an online consultation tool due to their personal circumstances. This may also result in inequitable access to care if patients are not aware of or unable to use other access routes.
• General practitioners have not always had specific training to undertake online consultations, resulting in some having concerns about the making of decisions based on the limited clinical information provided through an online tool.
• The design and configuration of an online consultation tool may mean it is not always able to safely deliver the task(s) it is being used for, nor address and meet the needs of its users (patients, carers and staff).
• The explicit needs of users are not always identified and incorporated into the design and configuration of online consultation tools. The needs of patients and staff may be different in respect to how a tool collects information about a patient’s medical problem.
• General practices engaged with during the investigation have had limited oversight and support from their former clinical commissioning groups and current integrated care boards when procuring and implementing online consultation tools. This has contributed to variation in how tools have been implemented.
• Limited patient engagement and education can lead to misinterpretation about how to access care. 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.

In this report HSSIB recommends that:

• NHS England undertakes an evaluation of the risks to patient safety of online consultation tools in general practice, taking into account the findings of this investigation, recent research, and the experiences of general practices. This is to identify and implement actions to support the safe delivery of care using online consultation tools in line with best practice.
• NHS England develops mechanisms for assuring that integrated care boards support general practices when implementing online consultation. This is to ensure online consultation tools are procured and implemented in ways that best support patient safety.