NHS GP practices are increasingly providing online services as patients demand faster and more convenient access.

These services include:

• making appointments
• ordering repeat medicines
• patients seeing their clinical record
• digital consultations.

The NHS Long Term Plan sets out digital transformation ambitions. It aims that every patient in England can access digital services and health information from their GP by 2023/24. The GP contract five-year framework plans extra IT funding so all patients can access digital-first primary care by 2021. This would include web and video consultations.

Providers must consider

The way you deliver services affects how safe they are.  The use of technology in healthcare is a continually developing field. Innovative ways of connecting patients and clinicians must not have detrimental impact to safe and effective care.

Establishing a patient’s identity

You must confirm who is seeking treatment, including their age and gender. Use the NHS Digital standards, NHS login, to establish online identity.

Safeguarding

Safeguarding systems must reflect the scope of practice and the type of online service offered. This includes:

• is the service is being provided in real-time?
• are children are being treated?
• across what geographical area are you delivering care?

Treating children

Take reasonable steps to be sure that any adults involved in the consultation:

• have parental authority and
• are able to provide consent on behalf of the child.

Assessing capacity and consent

The Mental Capacity Act (2005) applies in the online environment in the same way as for face to face settings. Staff should understand that patients must consent to care and treatment in line with legislation and guidance. They should ask for this consent.

You need effective systems to:

• identify issues relating to medical capacity
• perform the appropriate assessments.

Sharing information with other services

Appropriate information sharing contributes to clinical continuity and safe care. You should fully understand how patient data is used and, obtain and record valid consent. GMC guidance Good practice in prescribing and managing medicines and devices includes:

• sharing appropriate information relating to patient care
• patient consent for sharing information.

Retaining clinical records safely

Keep records in line with Department of Health and Social Care guidance. This includes making arrangements if you cease to trade. Within the NHS there are systems in place to facilitate this.

Information governance

Store patient information so it is secure and confidential. All communication methods, including email and video-conferencing, must meet information governance standards. You must carry out consultations in private and maintain the patient’s confidentiality.

Health-related apps

The NHS App library lists NHS-approved apps. If you recommend a healthcare app that is not from this library to a registered patient you must be assured it is safe and effective.

How we inspect NHS providers that offer online services

We use additional prompts alongside our assessment framework for healthcare services:

• online consultations - additional prompts for online services
• triage apps used as part of a pathway of care - additional prompts for triage apps supporting healthcare services.

We do not regulate standalone healthcare apps or symptom checkers.

More information

• NHS Digital’s DCB0160: Clinical Risk Management: its Application in the Deployment and Use of Health IT Systems - guidance about the responsibilities of providers.
• State of Care in independent online primary medical services - findings from our inspections.