Digital tools for online consultation in general practice

NHS England acknowledges the concerns raised by the HSSIB report and is currently undertaking work to enhance digital clinical safety and address HSSIB’s recommendation. NHSE has undertaken a considerable amount of work to enhance the safety of such products. In line with the commitment made in the National Digital Clinical Safety Strategy (2021), NHS England is reviewing its approach to the delivery of digital clinical safety training. One of the aims of the review is to improve awareness and understanding of digital clinical safety that supports capacity and capability across the NHS in England, both in healthcare providers and ICBs, to support them in identifying and managing digital clinical safety risks. Additionally, NHSE’s Digital Clinical Informatics Safety Team already offers online and in-person digital patient safety training which is tailored to the specific needs of requesting organisations and supports them in effectively fulfilling their responsibilities. The Digital Clinical Informatics Safety Team have recently undertaken a detailed review of the assurance process related to one of the online consultation tools that was made available from the ‘Online Consultations Frameworks’ portfolio to assess the robustness of the assurance process. This retrospective review showed that the assurance process was robust when considered in line with current assurance procedures. Additionally, regular review of some updated NHSE products occurs, and the Digital Clinical Safety Team are currently designing a new strategic approach to the review of all live NHSE products and those assured under historical frameworks. NHS England has recently commenced work to review and modernise the Digital Clinical Safety Standards – DCB0129 and DCB0160 . These mandatory standards are in place to ensure that healthcare IT suppliers and NHS organisations (including primary care providers) follow structured clinical risk management processes to identify, assess, and mitigate risks associated with digital health technologies both when the products are deployed and throughout their life cycle. The key intention of the consultation is to ensure relevance, effectiveness, improve usability, enhance alignment with broader NHS policies and prepare for future risks in new and emerging digital healthcare products. This will include developing an understanding of safety work needed in relation to AI-based products. Pre-consultation focus groups are currently underway, and views are being sought specifically from primary care and ICB colleagues. This work builds on NHS England’s Primary Care Patient Safety Strategy published in September 2024 that outlines specific roles and responsibilities within primary care for digital clinical safety. The Digital Clinical Informatics, Patient Safety and Primary Care teams in NHS England have discussed evaluation of online consultation tools and recognise the importance such an evaluation might bring. NHS England has close links to research centres where this kind of work takes place (such as the Health Foundation’s Improvement Analytics Unit) but is not funded to undertake such an evaluation directly. Therefore, our ongoing activities are focused on the points listed above. NB recent announcements to abolish NHSE and merge functions with the Department of Health and Social Care may have an impact on the work planned. These impacts, if any, are not yet clear. Actions planned to deliver safety recommendation: Review the Digital Patient Safety Strategy to ensure that training meets the needs of both ICBs and Healthcare Providers alike, by Winter 2025. Organisational lead: Deputy Director for Patient Safety NHSE. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26. Publication of the new DCB standards, by Autumn 2026. Organisational lead: CCIO NHSE. Development and implementation of an enhanced ‘live’ product review process, by Autumn 2025. Organisational lead: CCIO NHSE. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26. Exploring mechanisms for procuring and/or initiating an evaluation of safety of care delivery using online tools, by Autumn 2025. Organisational lead: Deputy Director for Patient Safety NHSE. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26. Response received on 6 November 2024. -------------------------------------------------- May 2026: HSSIB has been notified by the NHS England that all actions have been completed.

NHSE has been working to update and improve assurance processes across the NHS and to clarify roles and responsibilities between NHSE, ICBs and providers for assurance and performance management activity. This is expected to continue through the process of merging NHSE into the Department of Health and Social Care. The work includes strengthening and streamlining the assurance of ICBs in effectively commissioning services, improving service quality and securing transformation. Within this, there is also a specific programme underway to develop a more consistent approach across ICBs to carrying out their delegated responsibilities for commissioning of general practice, including supporting general practice transformation and improvement. ICBs are tasked with developing plans and delivering activity that supports general practice improvement, which will include ensuring that digital tools are implemented safely and effectively. NHSE will work with ICBs to assure these plans and track delivery of activities. Under the GPIT Operating Model, those procuring online consultation systems (which will largely be ICBs) are required to apply the provisions of DCB0160 when they are implemented and in the regular review of business and clinical processes. There are assurance processes in place to understand local application of the GPIT Operating Model and delivery of GPIT services. The effectiveness of these processes will be reviewed as part of the work mentioned above. In addition, NHSE has made available guidance and best practice tools for supporting the implementation of digital tools and application of clinical safety procedures. NB recent announcements to abolish NHSE and merge functions with the Department of Health and Social Care may have an impact on the work planned. These impacts, if any, are not yet clear. Actions planned to deliver safety recommendation: Publish NHS Performance Assessment Framework, by 2025 date TBC. Organisational lead: NHSE. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26. Additional comments: draft published 12 May for consultation. Publish details of a new Commissioning and Transformation Support Programme for GP commissioners, by 2025 TBC. Organisational lead: NHSE Primary Care and Community Services team. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26. Response received on 6 November 2024.