Key messages

• digitalisation has changed how older adults access primary care services
• language barriers and limited digital skills restrict access for some groups
• many participants preferred face-to-face or video consultations over online-only routes
• digital systems were associated with stress and frustration
• experiences of racial discrimination shaped trust in digital services.

Policy implications

• digital primary care should retain accessible face-to-face options
• language support and culturally appropriate design are essential
• video consultations may offer a more acceptable alternative to text-based systems
• digital strategies should explicitly consider the needs of minoritised older adults.

Gaps

• participants all reported a good level of English proficiency
• people with very low or no digital engagement were not included
• women were overrepresented, limiting insight into men’s experiences
• limited focus on social care compared with health services.

Commentary
This study provides insight into how digital primary care is experienced by older adults from minoritised ethnic backgrounds. While some participants were able to engage with digital systems, many described practical and emotional barriers linked to language, confidence and system design.

The findings show that digitalisation can increase existing pressures rather than ease access. Stress, reduced trust and a sense of being marginalised were common where digital routes replaced familiar ways of contacting services. Preferences for face-to-face or video consultations reflected a desire for clarity, reassurance and human connection.

Racial discrimination emerged as an important contextual factor. Past experiences influenced how participants interpreted digital change and whether they felt services were designed with them in mind. This highlights how technology interacts with wider patterns of exclusion rather than operating in isolation.

Overall, the study suggests that inclusive digital care requires more than technical solutions. Maintaining non-digital options, improving language support and addressing experiences of discrimination are central to ensuring that digital transformation does not widen gaps in access for older adults from minoritised communities.

Key messages

• remote consultations introduce specific patient safety risks compared with face-to-face care
• risks include missed visual and contextual cues and limitations on physical examination
• communication challenges can be amplified for some patient groups
• clinicians use mitigation strategies such as safety-netting, follow-up and selective face-to-face review
• safety risks may disproportionately affect underserved populations with communication or access barriers.

Policy implications

• remote consultation models should include explicit safety protocols
• clinicians need flexibility to switch between remote and in-person care
• training should address communication and risk assessment in remote settings
• patient safety considerations should be integrated into digital access policy and service design.

Gaps

• limited evidence on how safety risks vary across different patient groups
• lack of data on trade-offs between access, safety and equity
• need for further research on which populations are most affected by remote consultation risks.

Commentary
This paper highlights that the use of technology in care brings distinct patient safety challenges, particularly in remote primary care consultations. While remote access can improve convenience, it can also reduce clinicians’ ability to assess subtle cues or conduct physical examinations.

In terms of care equity, these risks are not evenly distributed. Patients with communication difficulties, language barriers or complex needs may be more vulnerable to harm in remote settings, especially if digital consultations become routine.

The study highlights the importance of mitigation strategies such as clear safety-netting and the option of in-person review. These approaches recognise that remote care should be adaptive rather than uniform.

Overall, the findings reinforce the need for balanced digital strategies. The use of technology in care must carefully weigh safety and equity alongside access, ensuring that digital delivery enhances care without increasing risk for already underserved groups.