Risks of delivering care by telephone or video in general practice: review of national complaints data.

Abstract

Remote consulting was rolled out across general practice in 2020 in response to the COVID-19 pandemic. Although most consultations are carried out safely, there are some cases where remote care may contribute to adverse outcomes. To understand the risks of delivering care by telephone or video in general practice. The learning validation national summary of primary care complaints was obtained from NHS England for quarter 4, 2020-2021 to quarter 4, 2021-2022. A thematic analysis was performed on these cases by reviewer 1, with validation of themes by reviewer 2. Common areas of risk in relation to telephone and video consultations include repeated telephone consultations with the same patient, especially for patients with vague symptoms or those at high risk; a failure to review chronic problems face to face; failures of practice processes, failure to listen, for example, to a patient or relative saying that a face-to-face appointment is required; and over-confidence in diagnoses reached without physical examination. In children, risk related to inappropriate barriers to face-to-face consultation and a failure to recognise conditions requiring urgent treatment.Medical conditions that were more likely to result in harm, included breast lump, chest pain and breathing difficulties, abdominal symptoms, trauma, non-resolving skin problems, and palliative care. Analysis of complaints gives pointers for action on improving awareness and training for GPs and practice teams around risks when consulting remotely.