The Doctors’ Association UK (DAUK) has responded to the Government’s plans to launch a new digital hospital service by 2027.
Announced today by Prime Minister Sir Keir Starmer, NHS Online aims to cut waiting lists by allowing patients referred to hospital by their GP to speak to specialists via phone or video rather than attending face-to-face appointments.
While DAUK welcomes innovation, our committee members have raised concerns the service may fail to address the root causes of delays in hospital care and could even pose risks to patient safety.
Quality of care
DAUK co-chair Ms Helen Fernandes warned that the proposals could exclude some groups of patients and risk lowering the quality of care.
She said: “I hope it helps as we do need innovation.
“While there are areas within hospital healthcare that an app and remote appointments will work well, there are probably more in which it will not.
“It will potentially disadvantage the older generation, those who do not have a smartphone, or have disabilities that make their use difficult.”
NHS Online
Ms Fernandes also questioned whether online consultations would save any clinician time.
Speaking on LBC radio, she said: “A phone call to a doctor to carry out a clinic doesn’t save our time.
“We spend as much time with the patient as we would face-to-face.
“The problem sits with the resources there are to look after patients.
“We don’t have enough doctors, yet we have many unemployed doctors and a doctors training in crisis. So providing that service in 2027 and beyond is a risk.”
Jess’s Rule
Ms Fernandes also highlighted the new Jess’s Rule and the potential risks of over-reliance on remote care.
“Jessica’s care was compromised because she had a series of telephone and online consultations,” said Ms Fernandes.
“In my mind, the two don’t quite fit together in terms of quality of care for patients.”
Other DAUK members voiced specialty-specific concerns.
Physical examinations
Dr Shonnelly Novintan, DAUK Learn Not Blame lead and a plastics registrar, emphasised the importance of physical examinations in dermatology and plastics.
She said: “All our skin clinics need physical examinations and lymph node palpations in line with BAD and AJCC guidelines.
“People may think it is something that can be easily stepped down as ‘take a photo of your mole and send it in’ but we have to be examining the mole and lymph nodes to determine next steps.
“We risk further delaying patients by seeing them virtually first and then in person and that delay could be dangerous in aggressive skin cancers.”
Neurology presents similar challenges, said DAUK’s Dr David Nicholl.
Patient safety
Speaking on BBC Radio 2’s Jeremy Vine Show, he said: “There are many situations in neurology where you have to examine the patient and virtual scenarios can be risky.
“I can think of a couple of patients I’ve seen in the last couple of years where they had a very clear diagnosis of motor neurone disease.
“They had gone through all number of two-week pathways and had not actually seen someone. It was very obvious when someone examined the patient there was a problem.”
Dr Nicholl warned that an expansion of online access could ‘swamp’ the system without increasing the number of doctors.
“In neurology, for example, we’ve got the lowest number of neurologists per head of population in pretty much all of western Europe,” he said. “Without the increase in capacity I can’t see how it can work.”
Lack of doctors
DAUK stressed the biggest barrier to reducing waiting lists was not a lack of digital platforms but a lack of doctors.
“More clinician time. More doctors,” Ms Fernandes said. “If you want efficiency, speed, and reduction in waiting times, in our view this needs to be looked at.”
DAUK committee members are all volunteers and speak to the media about issues facing frontline doctors in their own time. Please support our work by joining DAUK or donating to our GoFundMe.
