Digital healthcare has transformed general practice. What began as an emergency response during the pandemic is now embedded in everyday care, accelerated by the NHS Digital First agenda and the boom in private online health services.
For patients, the appeal is clear: faster access, shorter waits and greater convenience. Practices, meanwhile, hope to use clinical time more efficiently. Yet remote care is not suitable for every consultation and it brings new risks and medico–legal pitfalls. Recent increases in complaints involving remote consultations highlight the importance of balancing innovation with robust safeguards.
The rise of digital first general practice
Technological advances mean GPs and patients now have access to an array of tools: consultations by phone, video or messaging; integrated digital records; and AI-powered triage and advice platforms. The NHS 10 year health plan encourages the use of digital technology, and with the rollout of the NHS Digital First Programme,practiceshave needed to adapt to make online consultation tools available during core hours.
Notably, patients seeking prescriptions are now more likely to use an app or their GP website than to pick up the phone. The adoption of digital tools into a hybrid model, alongside telephone and in-person options, has the potential to improve patient satisfaction as it provides choice and speedier access.
When implemented well, digital healthcare and remote consultations may bring further advantages: saving time for patients and clinicians, reducing travel burdens for frail patients, facilitating triage, medication requests and follow-up, and reducing administrative pressures.
The challenge lies in balancing these potential benefits with the need for strong safeguards to patient safety.
The clinical and medico-legal risks of remote care
Despite its growth and potential advantages, remote consulting has inherent limitations and most GP appointments still take place face to face. Practical and clinical challenges persist: communication cues may be reduced, negatively affecting the GP-patient interaction; clinical examination is limited; and technology may fail or be poorly integrated with clinical systems.
Certain patient groups may be particularly at risk or disadvantaged if remote consultation is used inappropriately; in particular, patients lacking digital literacy, those with communication or language difficulties, or individuals presenting with complex or unresolved symptoms requiring examination.
Although the majority remote consultations are conducted safely, there remains potential for harm if things go wrong. Complaints and claims may arise from issues such as diagnostic delays due to incomplete assessment, missed opportunities for clinical or safeguarding intervention, or remote prescribing without sufficient clinical information.
Sometimes the risks are due to subtle limitations in system design rather than overt clinical error. For instance, if a patient submitts an online consultation form describing chest discomfort and fatigue, but the digital triage system categorises the request as ‘routine’ based on symptom keywords, the need for urgent examination could be overlooked,potentially leading to harm.
Suchscenariosreinforce the need for structured safeguards, appropriate training, and sound professional judgement.
What good remote practice looks like
In this technology-enabled environment, GPs must ensure that virtual care meets the same standards as in-person appointments.In Good Medical Practice, the General Medical Council (GMC) states: “If you can’t provide safe care through the mode of consultation you’re using, you should offer an alternative if available, or signpost to other services”.
The GMC also provides a flowchart within its remote consultations guidance to help GPs decidewhen remote care is appropriate.
Healthcare professionals are expected to follow the GMC’s ten high level key principles for remote consultations and remote prescribing:
- Make patient safety the first priority and raise concerns if systems do not include appropriate safeguards.
- Understand how to identifyvulnerable patients and take appropriate steps to protect them.
- Identify themselves, establish a dialogue, and ensure the patient understands how the remote consultation will work.
- Prescribe only if it is safe to do so.
- Obtain informed consent and follow relevant mental capacity law and codes of practice.
- Undertake an adequate clinical assessment and access medical records or verify important information.
- Give patients information about all available options in a way they can understand.
- Make appropriate arrangements for aftercareto support ongoing monitoring and treatment.
- Keep notes that fully explain and justify decisions made.
- Stay uptodate with relevant training, support and guidance for providing healthcare remotely.
The importance of ensuring continuity of care
The GMC highlights continuity of care as a key issue in remote settings. Where the consulting clinician is not the patient’s usual GP, appropriate consent for accessing and sharing their records must be established. If consent is refused, the clinician must explain to the patient the potential impact on their care, and carefully consider whether it is safe to proceed with treatment. Any decision should be clearly recorded and justifiable.
This aligns with the GMC’s remote prescribing guidance; clinicians must be satisfied that they can adequately assess the patient, and should prescribe remotely only when they have adequate knowledge of the patient’s health.
Failure to comply with GMC guidelines may expose clinicians to complaints, litigation or regulatory investigation.
For example, concerns have been raised about inappropriate prescribing of weight-loss medications via private online platforms. If a clinician were to prescribe without verifying the patient’s medical history, and the patient subsequently developed a complication linked to an existing contraindication, this could lead to legal or regulatory action.
Practice-level governance and policy considerations
GPs and practices should pay close attention to the particular legal, regulatory and safeguarding considerations of digital healthcare and remote consulting. Establishing local policies that reflect theGMC guidanceand the needs of the local communitycan help to avoid common pitfalls.
NHS England provides a summary of policies and protocols that practices may need to reviewing relation to remote consulting, including:
- Consent and confidentiality
- Capacity
- Adult and child safeguarding
- ‘DNA/Was not brought’ policy
- Emergency management
- Clinical safety risk assessment for digital tools or health IT
- Clinical images and photographs
- Intimate examinations and chaperoning
- Remote prescribing
- Health and safety, remote working, remote consulting
- Staff training.
The BMA also provides a checklist covering safety, governance, legal and regulatory requirements for practices when choosing an online consultation platform. In addition, NHS England’s Digital Primary Care: The Good Practice Guidelines for GP electronic patient records is a comprehensive resource covering many topics including system functionality, clinical safety, information governance, data protection, data sharing, and online patient facing services.
In Online consultations – frequently asked questions and support resources, NHS England clarifies the requirements for making online consultation tools available during core practice hours. Patient safety concerns were highlighted by a BMA surveyin which some practices reported receiving urgent requests submitted via systems designed for non-urgent matters. NHS England recommends safeguards against this, such as displaying a clear message or banner on the practice website and online consultation platform advising patients to raise urgent clinical concerns in person or by telephone.
Indemnity and risk protection in digital healthcare
By embedding safeguards into digital workflows, practices support GPs in delivering accessible care without compromising patient safety or professional standards.
However, as digital healthcare models expand, clinicians must adapt to the changing medico-legal risks. Although state-backed indemnity schemes cover clinical negligence claims arising from NHS-contracted services, GPs should review whether any aspects of their work falls outside this scope. The GMC states that indemnity arrangements must reflect the full scope of a clinician’s work. This is particularly important for those involved in private online services, digital triage systems, or remote prescribing outside NHS contracts.
At Medical Defense Society, we support GPs with tailored indemnity protection and expert medico-legal advice, helping them navigate the evolving standards of digital and remote care. As we continue to observe complaints arising from remote consultations, early advice can be invaluable in mitigating risk and resolving concerns.
Contact us to check whether your indemnity arrangements cover all digital and remote activities or if you need advice about implementing appropriate safeguards.
