Remote GP consultations carry risks for some urgent conditions – and practices and patients need to take steps to avoid this, according to a major new analysis.

The risks include new chest and abdominal pain, palliative care, injuries and diabetes, according to the latest findings of a project involving the University of Oxford and the Nuffield Trust. Researchers say that practices should “strongly” consider face to face consultations when patients do not improve after a remote consultation and when patients have an existing complex illness.

The study also identifies the patients who may be most difficult to assess by remote means – such as the very elderly, the very young, patients in some care settings and those with communication challenges. The researchers, reporting in BMJ Quality and Safety, analysed 95 safety incidents and studied 12 practices in England, Scotland and Wales. They stress that safety incidents remain “extremely rare”.

The report does not attempt to calculate the incidence of problems but includes the findings of interviews with doctors in the 12 practices taking part in the study. This led to the researchers citing several examples of safety practices. This included ensuring that doctors, not receptionists, assessed the “red list” of patients seeking urgent call backs. Examples also included a patient seeking only a phone call in order to get pain medicine – while a GP registrar insisted on seeing them in person, leading to diagnosis of myocardial infarction.

Researcher Professor Trish Greenhalgh, from the University of Oxford, 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.”

Dr Rebecca Rosen from the Nuffield Trust said: “Remote consulting is here to stay and the study has identified ways in which to ensure quality and safety. Every clinician must be aware of high-risk symptoms for which it’s safer to see patients face to face; must listen and respond carefully to patients who say they need an in-person appointment and should consult face to face if a patient has not improved after previous remote consultations. We can also ensure that patients have the knowledge and tools to help them to get the best out of their consultations.”

The vice-chair of the Royal College of GPs, Dr Victoria Tzortziou-Brown said the report had some “helpful” proposals.

She said: “The majority of consultations in general practice – more than 70% in September – are carried out in person. But a lot of high quality, safe care is delivered remotely in general practice on a daily basis, as this research makes clear. It is important that GPs and our teams are able to offer patients access to our services in a variety of ways, and whilst many patients prefer to see their GP face to face, many appreciate the convenience that remote consulting offers. The College’s position is that the method of consulting should be a shared decision between clinician and patient based on clinical need, and clearly remote consultations will be more appropriate for some patients than others.

“Whilst there is risk associated with all medical consultations, delivering remote care comes with specific challenges and limitations, as highlighted by this research. It makes a number of helpful recommendations in terms of identifying patients for whom remote care may not be appropriate and to support GP teams to ensure remote consultations are delivered as safely as possible.”