As a direct consequence of the outbreak of coronavirus in the UK, GPs have been urged to avoid face to face consultations and assess patients virtually. The aim of this is to reduce the spread of the COVID-19 throughout our communities.
A number of practices already routinely offer remote consultations, but the current circumstances mean that the majority of GP consultations may need to take place remotely. In some respects, this may increase the risk of issues arising from consultations, such as missing a diagnosis or failing to investigate symptoms.
The GMC has published helpful advice in respect of remote consultations – here is a summary.
Consent – as usual, consent is important. The GMC advises that you should give patients information about all the options available to them (including the option not to treat) in a way they can understand. You should tailor the information you give, and the way you give it, to patients’ individual needs, and check that they have understood it. If you are not sure a patient has all the information they want and need, or that they’ve understood it, consider whether it is safe to provide treatment and whether you have valid consent. You must ensure you can assess a patient’s capacity. If a patient lacks capacity to make a decision, consider whether remote consultation is appropriate, including whether you can meet the requirements of mental capacity law.
Continuity of care – where possible, doctors and patients should maintain continuity of care. It is recognised that this may not be possible during this difficult time. The GMC advises that if you are not the patient’s GP, you should ask the patient for consent to get information and history from their GP and to send details of any treatment you have arranged. If consent is refused, you should explore their reasons and explain the potential impact of their decision on their continuing care. If the patient continues to refuse, consider whether it is safe to provide treatment. It is also important to make a clear record of your decision and be prepared to explain and justify if asked to do so.
Work within limits of competence – despite these challenging times, it is important that everyone continues to work within the limits of their competence.
Indemnity – the GMC advises doctors to check indemnity cover to make sure that you have the appropriate level of cover. You should first check the website of your medical defence organisation. For example, if you are a member of the MDU, they have stated that you do not need to inform them if you are undertaking telephone or video consultations. However, you do need to let them know if you undertake telehealth work.
Some concerns that CQC has previously identified in respect of remote consultations include inappropriate prescribing of antibiotics and inadequate approaches to safeguarding children and those who do not have capacity. These are also important factors to be cognisant of when conducting remote consultations.
It is also important to ensure you are correctly registered with CQC, as carrying out remote services is a regulated activity under these Regulations. The guidance for doctors providing remote advice is scarce, but it is important to note that remote advice is a regulated activity when all of the following apply:
- the advice is medical;
- it constitutes triage or is responsive (for immediate attention or action as opposed to, for example, a service in which a person electronically submits questions to a provider who provides responses at some later time, or when a person seeks general health care or lifestyle advice);
- it is provided over the telephone or by electronic mail; and
- it is provided by a body established for that purpose (as opposed to, for example, the occasional provision of advice by a body such as a hospital or university on an informal basis).
To clarify, those GP services providing routine appointments and treatment of medical conditions electronically, do not need to be registered for the regulated activity of remote services. However, if you provide urgent medical advice or triage, such as the 111 service, or you use a vehicle to transport patients, then you do need to be registered to provide the regulated activity of remote services. Further information can be found on CQC’s website. If you have any queries or concerns about registration, you should get in touch with CQC.