CQC warns ‘digital by default’ could deepen NHS inequalities

The Care Quality Commission (CQC) has warned that the NHS’s shift to digital risks excluding vulnerable patients and widening existing health inequalities.

In its ‘State of health care and adult social care in England 2024/25’ report, published on 24 October 2025, the regulator says that the digital ambitions in the government’s NHS 10 year health plan must not come at the expense of equity.

Sir Julian Hartley, former chief executive of the CQC, said in the report’s foreword that there are “too many instances where poor coordination between health and social care, inadequate information sharing, and a lack of digital integration is creating barriers to good care.”

The CQC’s findings show that online and video consultations have grown since the pandemic, accounting for 5.5% of all GP appointments in 2024/25, compared with 0.6% in 2022/23. 

In the 2025 GP Patient Survey only 53% of people reported that they found it easy to contact their GP by phone, and 35% said it was difficult. 

Feedback from autistic people and people with mental health concerns found that GP practices “do not always offer the reasonable adjustments needed to support them to make appointments online or by telephone,” the report says.

These barriers also affect groups, such as older or frail people, who may struggle to use digital booking systems or apps because of accessibility barriers or limited digital skills. 

“As the government commits to going ‘digital by default’ in attempts to end the 8am scramble, practices will need to consider how to implement change in ways that minimise digital exclusion and consider the impact of health inequalities,” the CQC says.

It adds that “choice and flexibility” must remain central to digital access strategies.

The CQC warns that local systems should have “effective processes to ensure that vulnerable people without advocates – whether formal or informal – are not at a disadvantage when navigating the health and care system, and receive the support they need”.

Commenting on the report, Kathryn Marsden OBE, chief executive of the Social Care Institute for Excellence, said: “This report provides further evidence that people living in the most deprived areas often experience poorer outcomes and encounter greater barriers to accessing care.

“Older people, people with dementia, people with learning disabilities and autistic people, and people with complex mental health needs are also struggling to navigate services and access the support they need.”

The CQC also found that attitudes towards the adoption of AI in healthcare remain mixed, with a poll of 2,000 members of the public finding that 47% felt negative about its use, while 83% were worried about potential errors and 81% feared a loss of human connection.

According to a survey of GPs, 42% of practices are using AI, mainly for administrative tasks such as note-taking, triage and appointment scheduling. 

More than four in five (81%) GPs believe that AI will have a positive impact on general practice within five years, but 73% of GPs cite lack of funding, 69% unclear regulation, and 66% liability concerns as barriers to adoption. 

Meanwhile, Hartley announced on 23 October that he is stepping down as chief executive of the CQC.