Equity impacts of digital-by-default primary care in minoritised ethnic communities

Key messages

• digital access routes such as e-consultations and online triage often replicate or worsen existing access barriers
• limited access to devices, data and reliable internet inhibits use of digital primary care
• lack of language support and English-only digital interfaces reduce accessibility
• digital systems are frequently poorly aligned with users’ needs and circumstances
• GP staff often rely on informal, ad-hoc workarounds to support patients excluded by digital systems.

Policy implications

• digital-by-default approaches risk widening inequalities if alternative access routes are not protected
• primary care digital systems should be designed with language support and accessibility in mind
• investment in digital inclusion alone may be insufficient without service design changes
• practices may need clear guidance and resources to support equitable access rather than relying on informal workarounds.

Gaps

• limited evidence on long-term impacts of digital-by-default models on health outcomes
• lack of quantitative assessment of exclusion at population level
• limited evaluation of which design changes most effectively reduce digital barriers.

Commentary
This study highlights how the use of technology in care can deepen inequalities when digital systems become the default route for access. For adults from minoritised ethnic communities, barriers linked to device access, data affordability and language support intersect with existing structural disadvantages.

The findings challenge assumptions that digital access is inherently efficient or inclusive. Where systems are designed without consideration of lived experience, technology can displace barriers rather than remove them. From an equity perspective, this raises concerns about who digital transformation is designed for and who it leaves behind.

The reliance on informal staff workarounds illustrates the strain placed on frontline services. While these adaptations may help individual patients, they are inconsistent and fragile, masking systemic exclusion rather than addressing it.

Overall, the study highlights that the use of technology in care must be accompanied by inclusive design, meaningful alternatives and organisational support. Without this, digital-by-default models risk reinforcing inequities in access to primary care rather than reducing them.