Patients, especially older people, are at risk of remote consultations with their GP, according to a major study

Online and telephone GP appointments can lead to serious illnesses being missed and put patients at risk of making fatal mistakes, a major study has found.

Elderly people and others with urgent medical conditions face misdiagnosis and potentially fatal delays in care that would be less likely if they were seen in person, the analysis indicates.

They found that poor relationship building and insufficient information gathering put patients at greater risk of underdiagnosis or incorrect treatment.

People with communication problems – especially the elderly and very young – are at greatest risk and should always get face-to-face appointments on request, researchers suggest.

A team from the University of Oxford, Plymouth and the Nuffield Trust examined data from 95 safety incidents in the UK between 2020 and 2023, including complaints, reports and settled claims.

The chart shows the relationship between GP patients and practices. The latest data from NHS England shows that there are an average of 9,740 patients per surgery

In several safety incidents, doctors assumed that a diagnosis made during a remote consultation was final and not provisional.

Serious errors — including some deaths — related to serious medical conditions such as sepsis, congenital heart defects, cancer and diabetic foot complications “could probably be easily diagnosed by an in-person examination,” they said.

“Especially when subsequent consultations have occurred remotely, such errors can become entrenched, leading to overshadowing of the diagnosis and missed or delayed diagnoses.”

In one case, a 16-year-old girl died of sepsis after a family doctor spoke to her older sister on the phone and misdiagnosed glandular fever.

Another case involved a woman in her 70s who suddenly became short of breath and was told she would be recalled.

But the GP’s receptionist was distracted by a patient in the waiting room and the call never went through, resulting in the telephone patient’s condition deteriorating and him dying at home that afternoon.

Elsewhere, NHS 111 staff failed to diagnose a pregnant woman with premature rupture of membranes and instead she was excluded from a “urinary problems algorithm”.

Other cases involve a missed pulmonary embolism in a new mother that led to her death, and missed congenital heart defects in an infant.

In some cases, GPs themselves acknowledged the limitations of external consultations.

One GP said: “I remember a father calling.” It really didn’t seem that alarming.

“And I really played it down, and when I was on a video call, you know, this kid … had an intercostal recession … looked really, really bad. And it was actually quite scary that you had that conversation and if you’d just listened to what Dad said, you probably wouldn’t have worried.”

Researchers said that patients with underlying medical conditions are particularly difficult to assess over the phone, especially those who have had or are worsening multiple medical conditions.

Clinical conditions that were difficult to assess remotely included possible heart pain, acute abdomen, difficulty breathing, vague and generalized symptoms, and symptoms that worsened despite treatment.

Researchers found that primary care practices are suffering from staff shortages and high demand.

The study, published in the BMJ, recommended that doctors ensure that the patient is informed about the next steps in their treatment and make it clear to patients if their health deteriorates.

Professor Greenhalgh, senior researcher at the University of Oxford, said: “The vast majority of remote clinical consultations in general practices are safe, largely because staff are vigilant and err on the side of caution.”

“Organizational pressure and poor communication often play a big role in security incidents.”

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

Dr Rebecca Rosen, author of the study at the Nuffield Trust, said: “Remote counseling is on the rise and research has highlighted ways to ensure quality and safety.”

“Every doctor should be aware of the high-risk symptoms for which it is safer to see patients in person; You should listen carefully and respond to patients who say they need an in-person appointment, and seek personal advice if a patient has not shown improvement since previous remote consultations.

“We can also ensure that patients have the knowledge and tools to help them get the most from their consultations.”

The latest data for England shows that 71 per cent of GP consultations take place in person, while 24 per cent take place over the phone.

The claim is that the NHS is discriminating against older patients, with one in six GP practices now only accepting online bookings.

Dr Victoria Tzortziou-Brown, vice-president of the Royal College of GPs, said there was a lot of high quality, safe remote care being provided in general practice every day.

She said: “It is important that GPs and our teams can offer patients access to our services in a variety of ways and although many patients prefer to see their GP in person, many appreciate the convenience of remote consultation.”

“The board believes that the type of consultation should be a joint decision between doctor and patient based on clinical need, and it is clear that remote consultations are more suitable for some patients than others.”

“While all medical consultations involve risks, remote care presents particular challenges and limitations, as this study shows.” There are a number of useful recommendations to identify patients for whom remote care may not be suitable and to support primary care teams to ensure remote consultations are carried out as safely as possible.”