Patients risking their life using online forms to report potentially deadly conditions, GPs warn

Patients are using new online booking forms to report potentially life-threatening conditions in a major risk to safety, GPs warn.

An updated NHS contract that came into effect on October 1 means surgeries must allow appointment requests to be submitted via their website between 8am and 6.30pm.

The change was intended to improve access and end the 8am telephone scramble for appointments.

But doctors say patients have been using the forms to report the likes of breathing difficulties, severe vomiting, acute abdominal and chest pain, and rectal bleeding.

The British Medical Association has argued that because the systems cannot tell the difference between routine and urgent enquiries, serious problems could be ‘lost inside the huge haystack of unmet patient need’.

The Government has repeatedly dismissed the union’s concerns, with health secretary Wes Streeting insisting there are ‘clear’ safeguards and it is ‘absurd’ that people can book a haircut online but some GPs still refuse to let patients make appointments in the same way.

Now a survey of 431 GPs and practice managers, by trade magazines Pulse and Management in Practice, reveals more than two in three (67 per cent) are concerned the contractual changes could compromise patient safety.

Several GPs responding to the poll said urgent requests involving unwell or feverish children had been submitted through the online forms.

And one medic said they had received an online request from a patient at 6.25pm 'stating that they are suicidal'.

The BMA has entered into dispute with the government and could take industrial action over the matter.

Dr Caroline Delves, a GP partner in Norfolk, said her practice has received multiple serious clinical queries through administrative online forms since 1 October.

She said: ‘Since the contract changes, we've had one six-week-old baby with a red lump that was growing on an admin form, and another five-week-old who was lethargic and vomiting.

‘On Monday, I had a form through from a 35-year-old man on a non-urgent medical condition form saying he couldn't breathe.

‘When I rang him up, he really didn't sound very well and he wasn’t able to swallow.’

The patient was able to go to A&E, but Dr Delves said he could conceivably have been waiting far longer to be signposted.

She added: ‘That's on a form that's supposedly non-urgent - he could have sat there until we'd got through the other 70 forms we had to look at, which would have been unsafe.

‘We had someone on a Monday who disclosed they had been vomiting blood all weekend on a Monday morning via a change of address admin form.

'I think there's probably a level of health literacy expectation in the policymakers that doesn't exist for everybody on the ground.'

Another GP said: ‘Patients have mentioned suicide and a colleague had an asthma attack patient contact after 5.30 pm. We did deal with both but they could have been waiting until the next day.’

GPs responding to the survey highlighted the risk of having a free text box option for patients to make online submissions, which is increasing the chance serious issues will be missed.

One GP in the South East said: ‘I cannot believe how many patients are putting urgent clinical requests in the admin free text boxes.’

This included symptoms like severe vomiting and abdominal pain, a patient being pregnant with vomiting, and rectal bleeding.

Another survey respondent said the risk of burnout for GP practice staff caused by a surge in demand itself presented another risk to patient safety.

The West Midlands GP said: ‘We’re doing 340 to 400 medical triages on a Monday, and other days, 200 to 300. It’s overwhelming and unsafe.

‘Patients are dealt with quickly often through further symptom questionnaires (acute back pain, UTI, pill, cough etc) but it will burn us out.

‘By the time 5pm comes and admin needs to be done it’s hard to concentrate on the septic, suicidal or end-of-life patients that we try to prioritise between all the queries that are overwhelming us.’

Another GP said: ‘Processing online requests and triaging after a 13-hour intensive clinical day is unsafe and unsustainable.’

Dr David Wrigley, deputy chair of the BMA’s GP committee, said: 'It’s deeply worrying – and sadly unsurprising – that GPs are concerned for patient safety as a result of these contract changes.

‘We warned the government repeatedly in the past six months that allowing unlimited online consultation requests without the necessary safety measures or additional resources would overwhelm already stretched teams, divert doctors from face-to-face appointments, and risk urgent cases being missed.

‘General practice is not against the use of technology and have been embracing it for over 30 years, but innovation without safeguards is dangerous.

‘We believe there is significant risk to patients and to our practice teams from this new initiative, and the Government must provide the protections it committed to back in February.’

Dr Amanda Doyle, national director for primary care and community services at NHS England, said: ‘It is right that patients should be able to contact their GP practice online – in addition to by phone and by walking in – which is why it was agreed by the BMA’s General Practice Committee in February.

‘In the many practices already offering this service, patient satisfaction is higher.

‘Patient safety remains our priority and guidance and support has been provided to practices to help them put the necessary safeguards in place for urgent clinical requests.’