Safety risks in online primary care consultations

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.