The widespread adoption of remote consultations by GPs in 2020 as the pandemic took hold was a practical solution to the prohibition on face to face meetings. Since then, they have become a permanent fixture as the system proved effective for many patients, not all of whom needed to see their GP in person, thus saving both time and money. However, concerns that this method of interaction could be unsafe for some patients were backed up by 2021 Public Health England data. This revealed that thousands of people with cancers and other potentially life-threatening conditions, such as stroke and heart attack symptoms, had either failed to seek medical help or if they did, were not correctly diagnosed. In the light of this, a recent study by an Oxford University-led research team, has looked at the connection between remote consultations and safety incidents and has concluded that for most patients the risks are minimal.
Vulnerable patients at higher risk of misdiagnosis
However, there is a small but important group of patients for whom the risk of misdiagnosis was found to be higher than average, particularly those with complex or multiple pre-existing conditions, those exhibiting vague or generalised symptoms, and those who struggled to communicate what was wrong. The report's purpose was to highlight those patients and conditions for whom remote primary care is not always appropriate and suggest ways in which training could help to identify where the risks lay and how to mitigate them. Many of the safety incidents recorded in the research study arose from several things occurring simultaneously such as high demand, staff shortages and high staff turnover. Some practices' triage systems were difficult to navigate by those who struggled with technology, others enforced a rigid approach to their triage system, insisting that no face to face appointment could be offered unless a telephone consultation had been held first, and some expected non-clinical staff to make clinical judgments for which they were not adequately trained.
Maximising the benefits of technology while minimising the risk
This report is timely and not just because it reveals where the risks lie but also, as importantly, because it shows that 'examples of deaths or serious harms associated with remote encounters in primary care were extremely rare'. The circumstances in which problems arose are unsurprising given that many practices are still in the process of transitioning from an 'analogue' to a 'digital' way of working so not all have the right technology or training programmes in place.
The report's general observations on how to maximise the benefits of remote consultations while mitigating the risks are also helpful. Among other recommendations, it advises updating and adapting systems and processes to handle remote consultations effectively; prioritising training in verbal communication for both clinical and non-clinical staff to ensure essential details are not missed; and identifying which patients will struggle with the system of remote consultation and the putting in place of an alternative approach for them. Failure to adapt will only lead to an increase in health inequalities for those who are already marginalised because of their physical and / or social circumstances.
Revolutionising the doctor/patient relationship
This report comes at a time when AI is increasing its reach within the healthcare system. It is even more imperative that the system is flexed and made more adaptive as new technology revolutionises the doctor / patient relationship. In the South West, several GP practices are in the process of installing an AI system which analyses patient records in order to predict who may be at risk of an unplanned emergency call-out. This is exactly the sort of tool that will help GPs to categorise their patients according to need, enabling a much needed degree of personalisation. Nonetheless, even technology used correctly is still only a tool – it is unlikely to replace a GP's eyes, ears, and hands any time soon.
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