EXCLUSIVE Practice managers and GPs have warned that new requirements around online requests are risking patient safety as urgent clinical problems are being flagged via online forms, results released in a survey today have revealed.
The survey of 431 GPs and practice managers in England conducted by Management in Practice and sister title Pulse found that 67% are concerned for patient safety as a result of contractual changes brought in on 1 October that mandate practices to ensure online requests can be submitted between 8am to 6.30pm.
Only 25% said they were not concerned the arrangement posed a risk.
GPs and practice managers have said that patients have been reporting breathing difficulties, severe vomiting, acute abdominal and chest pain, and rectal bleeding through online forms. Respondents to the survey also said that urgent requests involving unwell or feverish children had been submitted through the online tools.
In addition, practice managers flagged up that patients were reporting suicidal thoughts, head injuries, acute allergies and stroke symptoms. A patient even used the online tool to report they had drilled through their finger, findings showed.
One said the examples of clinical urgent problems coming through ‘routine’ patient online requests were ‘too many to list’, and several shared concerns that patients use it as an urgent service despite being told it’s not or that they think it’s a ‘real time’ offering.
At the same time, they expressed worries that patients often can’t distinguish between urgent and non-urgent clinical issues.
Respondents pointed out that currently there are inadequate safeguards against patients submitting urgent clinical requests through the online tools, and that burnout for GP practice staff caused by a surge in demand also presented a risk to patients – as well as staff safety (see box below).
One practice manager said they had already experienced two ‘significant events’. One was where the request came in late and the ‘triaging GP sent a task to reception staff at 6.29pm for a baby to go to A&E and the reception staff did not see the request until the next morning.’
It comes after the BMA has entered into a formal dispute with the Government over the online changes, arguing that they are currently not safe to implement because the systems can’t tell the difference between routine and urgent enquiries. As a result, it said, serious problems could be ‘lost inside the huge haystack of unmet patient need’ due to the changes.
However, the Government has repeatedly dismissed the concerns, with primary care minister Stephen Kinnock telling Pulse that he was confident necessary patient safeguards were in place ahead of the changes.
Dr Caroline Delves, a GP partner in Norfolk, said her practice has received multiple serious clinical queries through administrative online forms since 1 October.
She said: ‘Since the contract changes, we’ve had one six-week-old baby with a red lump that was growing on an admin form, and another five-week-old who was lethargic and vomiting.
‘On Monday, I had a form through from a 35-year-old man on a non-urgent medical condition form saying he couldn’t breathe. When I rang him up, he really didn’t sound very well and he wasn’t able to swallow.’
The patient was able to go to A&E, but Dr Delves said he could conceivably have been waiting far longer to be signposted.
She added: ‘That’s on a form that’s supposedly non-urgent – he could have sat there until we’d got through the other 70 forms we had to look at, which would have been unsafe.
‘We had someone on a Monday who disclosed they had been vomiting blood all weekend on a Monday morning via a change of address admin form.
‘I think there’s probably a level of health literacy expectation in the policymakers that doesn’t exist for everybody on the ground.’
She added that her practice is having to look at all of the forms as the come in, which is ‘drawing staff away from doing the rest of the work of the practice’.
Respondents also to the survey highlighted the risk of having a free text box option for patients to make online submissions, which is increasing the chance serious issues will be missed.
Removing free text boxes was one of the safeguards the BMA asked the Government to guarantee in a letter sent to primary care minister Stephen Kinnock last month.
Responding to the survey results, NHS England’s director for primary care Dr Amanda Doyle said: ‘It is right that patients should be able to contact their GP practice online – in addition to by phone and by walking in – which is why it was agreed by the BMA’s General Practice Committee in February.
‘In the many practices already offering this service, patient satisfaction is higher. Patient safety remains our priority and guidance and support has been provided to practices to help them put the necessary safeguards in place for urgent clinical requests.’
A Department of Health and Social Care spokesperson said: ‘In 2025 patients rightly expect to be able to contact their General Practice online – in fact, data shows that for the first time more patients are contacting their practice online than over the phone. The majority of practices have rolled out this service successfully and we are supporting others to increase compliance.
‘Patients submitting online requests for urgent issues should be told to phone their GP or attend in person. It is standard practice for GPs to direct patients to other services when that would better serve the urgency of their need. This is part of how the NHS system is designed to work efficiently and ensure patients get the right level of care.
‘In just one year, we’ve delivered millions of additional appointments to patients who need them, recruited more than 2,500 GPs across the country and provided an extra £1.1 billion of vital funding as we reverse more than a decade of neglect in our general practice services.’
What about GP staff safety?
The effect of the new online access changes on staff safety was also raised as a concern by several practice managers and GPs in our survey.
They pointed out that the new requirement has created additional workload, with one practice manager saying they were ‘worried about GP safety as a result of the changes.’
Another said it affected non-clinical staff too: ‘[We are] concerned about staff safety and wellbeing as this currently applies to reception who already do a great deal and feel the day to day pressures’.
GPs echoed their concerns.
A West Midlands GP said: ‘We’re doing 340 to 400 medical triages on a Monday, and other days, 200 to 300. It’s overwhelming and unsafe. Patients are dealt with quickly often through further symptom questionnaires (acute back pain, UTI, pill, cough etc) but it will burn us out.
‘By the time 5pm comes and admin needs to be done it’s hard to concentrate on the septic, suicidal or end of life patient that we try to prioritise between all the queries that are overwhelming us.’
Another GP in the North West said: ‘Processing online requests and triaging after a 12-13 hours intensive clinical day is unsafe and unsustainable.’
Our survey was open between 18 and 24 October 2025, collating responses using the SurveyMonkey tool. The survey was advertised to readers of Pulse and Management in Practice via our websites and email newsletters, with a prize draw for a £250 voucher as an incentive to complete the survey. The survey was unweighted, and we do not claim this to be scientific – only a snapshot of the GP and practice manager population.
