The must-read stories and debate in health policy and leadership.

An HSJ investigation has revealed serious safety concerns with remote GP appointments – which have been linked to five deaths since the pandemic hit. 

Senior coroner for Greater Manchester Alison Mutch has written five prevention of future deaths reports highlighting concerns that doctors missed significant details in telephone appointments, which might have been spotted had the patient been seen in person.

Safety concerns around digital and telephone appointments had already been highlighted before the pandemic. However, the rapid shift towards remote care for all practices and increasing workload for GPs has heightened the risk.

The reports cover a variety of conditions, including covid, a broken femur, and anxiety and depression. They all suggest that the severity of a patient’s condition was either completely missed or not fully understood by the clinician because appointments were carried out remotely.

The family of one of the patients, Stanislaw Zielinski, who was hospitalised when he fell from an upstairs window, said they struggled to communicate with a GP to explain his deteriorating health position.

Remote consultations were forced on general practice in order to support patients throughout the pandemic so it is unfair to blame the risks associated with them on primary care. But moving forward there needs to be a clear plan for how remote appointments fit into general practice to ensure the best for patients and their doctors. 

‘The wrong way to regulate hospitals’

The Care Quality Commission’s former chair Lord David Prior has said “very heavy handed, laborious and expensive” inspections have not been the right way of regulating hospitals.

Speaking at a Royal Society of Medicine webinar yesterday evening, Lord Prior spoke very candidly, saying that while there was a role for the CQC, he was “highly sceptical” as to whether any regulator can actually drive improvement.

Lord Prior, who was chair of the CQC from 2013 to 2015, said “there’s a sadness” the CQC hasn’t been able to develop a series of “predictive metrics” that would help identify an NHS organisation at risk of deterioration. This in turn could replace inspections, which he added are “pointless” unless they are “highly targeted”.

He said: “You need good people on the inspection. There’s no point turning up in the maternity department at UCLH with people who are not treated as serious people by the obstetricians and senior nurses. There’s no point.”

The CQC has for several years been indicating it will carry out fewer inspections, being more guided by data, and placing less burden on providers. But the CQC told HSJ: “Inspection will always be a valuable tool for understanding the quality of care.”