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

GPs are warning that patients are using new online booking forms to report potentially life-threatening conditions that pose a major risk to safety.

The updated NHS contract, which comes into force on October 1, means surgeries must allow appointment requests to be submitted via their websites between 8am and 6.30pm.

The goal of the change was to improve access and end the 8 a.m. phone call for appointments.

However, doctors say that patients use these forms to report complaints such as shortness of breath, severe vomiting, acute abdominal and chest pain and rectal bleeding.

The British Medical Association has suggested that serious problems can be ‘lost in the huge haystack of unmet patient needs’ because systems fail to understand the difference between routine and urgent examinations.

The government has repeatedly dismissed the union’s concerns; While health secretary Wes Streeting insists there are ‘clear’ measures in place and that it is ‘ridiculous’ that people can book haircuts online, some GPs are still refusing to allow patients to book appointments in the same way.

A survey of 431 GPs and practice managers by trade journals Pulse and Management in Practice finds that more than two-thirds (67 per cent) are concerned that changes to the contract could jeopardize patient safety.

Many GPs surveyed said urgent requests for sick or feverish children were submitted via online forms.

And a doctor said they received an online request from a patient “indicating suicidal thoughts” at 6.25pm.

The BMA is at loggerheads with the government and may take industrial action over the matter.

Dr Caroline Delves, a GP partner in Norfolk, said her practice had received a number of serious clinical inquiries via administrative online forms since October 1.

She said: ‘Since the contract changed we’ve had a six-week-old baby with a red lump growing into executive form and another five-week-old baby who is lethargic and vomiting.

‘On Monday, I received a non-emergency medical form from a 35-year-old man stating that he could not breathe.

‘When I called him his voice wasn’t really good and he couldn’t swallow.’

The patient was able to go to A&E but Dr. Delves said he could have waited much longer to be signposted.

He added: ‘This is in a supposedly non-urgent form; He could just sit there until we finished the other 70 forms we needed to look at, which would be unsafe.

Dr. David Wrigley, BMA GP committee vice-chairman

‘There was someone on Monday who announced via the change of address admin form on Monday morning that he had been vomiting blood all weekend.

‘I think there’s an expectation from policymakers for a level of health literacy that probably isn’t available to everyone in the field.’

Another GP said: ‘Patients talked about suicide and a colleague contacted the patient who had an asthma attack after 5.30pm. We took care of both but they may have waited until the next day.’

GPs responding to the survey highlighted that having a free text box option for patients to apply online increased the likelihood of serious problems being missed.

A GP in the South East said: ‘I can’t believe how many patients are sending urgent clinic requests to managers’ free text boxes.’

These included symptoms such as severe vomiting and abdominal pain, a patient becoming pregnant through vomiting, and rectal bleeding.

Another survey respondent said the increase in demand poses another risk to patient safety, with the risk of burnout for GP practice staff.

The West Midlands GP said: ‘We do 340 to 400 medical triages on Mondays and 200 to 300 on other days. This is very difficult and unsafe.

‘Patients are quickly dealt with through further symptom surveys (acute back pain, urinary tract infection, pill, cough etc) but this will exhaust us.

‘When 5pm rolls around and administration has to wrap up, it’s hard to focus on the septic, suicidal or end-of-life patients we’re trying to prioritize among all the questions overwhelming us.’

Another GP said: ‘Processing and prioritizing online requests after a busy 13-hour clinic day is unsafe and unsustainable.’

Dr David Wrigley, deputy chair of the BMA GP committee, said: ‘It is extremely worrying and unfortunately unsurprising that GPs are concerned about patient safety as a result of these contract changes.

‘Over the past six months we have repeatedly warned the government that allowing unlimited requests for online consultations without the necessary safeguards or additional resources would overwhelm already stretched teams, distract doctors from face-to-face appointments and risk urgent cases being missed.

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

‘We believe this new initiative poses a significant risk to patients and our practice teams, and the Government must deliver the protections it committed to in February.’

NHS England’s national director of primary care and community services, Dr. Amanda Doyle said: ‘It’s right that patients can contact their GP online as well as by phone and on foot, so it was agreed by the BMA’s General Practice Committee in February.

‘Patient satisfaction is higher in many practices that already offer this service.

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