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Patients dying as remote GPs miss serious illnesses

Patients are at risk of dying because remote GP appointments can miss serious illnesses including sepsis and cancer, research shows.

A team led by researchers from the University of Oxford examined 95 cases in which patients had died or suffered serious harm following GP appointments that were carried out by phone or video.

The study found that the switch away from face-to-face consultations has at times resulted in “missed, inaccurate or delayed diagnoses” and the “underestimation of severity or urgency”. Some of the errors related to conditions such as heart disease, sepsis and cancer “which would likely have been readily diagnosed with an in-person examination”.

The report examined safety incidents between 2020 and this year based on complaints, settled NHS compensation claims, reports and interviews with GP practice staff.

In one case, a 16-year-old girl died of sepsis after a GP spoke to her older sister on the phone and mistakenly diagnosed glandular fever. A woman aged 40 collapsed and died at home of a blood clot, six weeks after giving birth, the day after ringing her GP surgery with symptoms. She was told to take a coronavirus test and not given a face-to-face examination that may have led to an accurate diagnosis.

A woman in her seventies experiencing sudden breathlessness was told by a GP receptionist she would be called back, but this never happened and the patient died at home that day. Another elderly woman died when she had an incarcerated hernia — obstructing her bowel — but was misdiagnosed after a telephone consultation.

The report highlighted several cases in which cancers had been missed because of the lack of an in-person examination. This included a 35-year-old pregnant woman who had a telephone GP appointment after noticing a lump in her breast but was not offered an in-person appointment. She later had breast cancer diagnosed by a specialist.

The study, published in BMJ Quality and Safety, comes after the switch towards remote GP appointments during the pandemic, when most appointments were moved to phone or video. Data for England shows 71 per cent of GP consultations are in person, down from 80 per cent before the pandemic.

Researchers said mistakes via remote consultation were rare but there was a risk of patients being under-diagnosed or of less-qualified staff such as receptionists not acting on signs of illness.

The study found that patients with existing conditions, the very young and the elderly “were particularly difficult to assess by telephone”, while remote consultations were hard for patients without a smartphone.

GPs themselves realised the “scary” limitations of remote consultations, with one doctor recalling the father of a “really, really poorly child” not being concerned during a phone appointment — and the doctor only realising the seriousness during a video call.

Professor Trish Greenhalgh, from the Nuffield department of primary care health sciences within the University of Oxford, the report’s lead author, said: “The vast majority of remote clinical consultations in general practice are safe, in large part because staff are alert and err on the side of caution. When safety incidents happen, organisational pressures and poor communication often play a major role. This new research has identified more precisely where the risks lie and what measures we can take to reduce risks further.”

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