First reported 24 Mar 2014•Latest report 6 Aug 2025
Definition
What this concern includes
Includes failures of remote clinical consultations, including telephone or virtual consultations, where inadequate assessment, insufficiently thorough questioning, unreliable patient-provided information or failure to check understanding can make clinical advice or decisions unsafe.
Not included
Excludes face-to-face consultation failures where remote consultation is not the deficient process.
Excludes failures confined to a named pathway, such as telephone mental health assessment, GP appointment triage or emergency call handling, where that named pathway supplies the more specific supported boundary.
Excludes generic communication, documentation or follow-up deficiencies unless they directly impair the safety of a remote clinical consultation.
Excludes failures occurring after a remote consultation has been adequately completed, including subsequent treatment or service-access failures.
Reports
8
Distinct published reports
Individual concerns
10
A report can raise multiple concerns
Date range
2014–2025
First to latest report issue date
Stated actions
7
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Department of Health and Social Care5
NHS England3
Association of Ambulance Chief Executives1
East of England Ambulance Service NHS Trust1
Essex Partnership University NHS Foundation Trust1
Frimley Health NHS Foundation Trust1
Mid and South Essex NHS Foundation Trust1
NHS Greater Manchester Integrated Care Board1
NHS North East Hampshire and Farnham Clinical Commissioning Group1
North East Ambulance Service NHS Foundation Trust1
Royal College of Psychiatrists1
Royal College of Surgeons of England1
Yorkshire Ambulance Service NHS Trust1
Ministerial department5
NHS trust4
Executive non-departmental public body3
Clinical commissioning group1
Health professional body1
Health-sector membership body1
Integrated care board1
Professional body1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Inner North London
Concerns raised1
Reliance on unreliable patient-provided heart rate and blood pressure observations in remote consultations
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Prescribers, not the Department, decide whether medicines can be safely prescribed and must account for relevant national clinical guidance.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Suffolk
Concerns raised2
Failure of online prescribers to access patients’ records during consultations
Failure to assess suicidal behaviour or thoughts in online consultations
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
If an appropriate organisation requires a standardised suicidal-behaviour question, the GPhC would monitor its inclusion through inspections.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Essex
Concerns raised1
Failure to involve children directly in asthma service consultations
This report raised 10 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Request to speak with children during consultations and record their views in the electronic patient record.
Stated by Essex Partnership University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 12 December 2023.
Action
Require nurses to speak with sufficiently mature children and record children’s views in electronic patient records.
Stated by Essex Partnership University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 12 December 2023.
Manchester South
Concerns raised1
Failure to provide physical examination during telephone GP consultations where clinically needed
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Manchester South
Concerns raised1
Failure of GP consultation arrangements to support effective communication about deteriorating health
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Review patient experience feedback monthly to identify poor primary-care experiences and access inequalities.
Stated by NHS Greater Manchester Integrated Care Board and Tameside Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 26 August 2021.
Action
Discuss negative patient feedback with relevant practices to support learning and improvement.
Stated by NHS Greater Manchester Integrated Care Board and Tameside Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 26 August 2021.
Action
Introduce six-monthly patient surveys at individual practices from October 2021 to assess primary-care access and delivery.
Stated by NHS Greater Manchester Integrated Care Board and Tameside Borough CouncilStated plannedThe respondent said that this action was planned when they made their response on 26 August 2021.
Action
Conduct an individual practice clinician survey in October 2021 to assess primary-care delivery during the pandemic.
Stated by NHS Greater Manchester Integrated Care Board and Tameside Borough CouncilStated plannedThe respondent said that this action was planned when they made their response on 26 August 2021.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
National general practice guidance required remote triage and face-to-face appointments where clinically appropriate, addressing concerns about remote-only care.
Stated by NHS EnglandExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
The CCG cannot determine how GP consultations are undertaken because it lacks legal powers and is not party to the nationally negotiated contract.
Stated by NHS Greater Manchester Integrated Care Board and Tameside Borough CouncilOutside remitThe respondent said that this matter was outside its role or authority.
Position
Existing guidance, procedures and resources are considered sufficient to support safe remote general practice consultations alongside face-to-face appointments.
Stated by Department of Health and Social CareExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
South Yorkshire (Western)
Concerns raised2
Failure to provide written follow-up of advice from virtual consultations
Failure to assess patients’ understanding of advice during virtual consultations
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Routine written follow-up after every remote primary-care consultation is considered disproportionate; follow-up should be based on clinical judgment.
Stated by NHS EnglandExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Sunderland
Concerns raised1
Failure to make direct telephone contact with the patient during initial clinical review
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Implement the updated Urgent Ringback Procedure, prioritising direct conversation with patients wherever possible, and communicate it to relevant staff.
Stated by North East Ambulance Service NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 8 June 2018.
Surrey
Concerns raised1
Superficial and perfunctory nurse-led telephone consultations for enhanced recovery after laparoscopic surgery
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes failures of remote clinical consultations, including telephone or virtual consultations, where inadequate assessment, insufficiently thorough questioning, unreliable patient-provided information or failure to check understanding can make clinical advice or decisions unsafe.
