NOTE: The information within this article was correct at the time of publishing. However due to the fast-evolving nature of the pandemic, we strongly advise you to check all governmental and regulatory guidance for the latest updates.
Mounting pressures on NHS services have made digital solutions inevitable, but with new technology comes new risks. Dr Heidi Mounsey, medicolegal consultant at Medical Protection, advises on best practice.
With workloads, patient access and waiting times continuing to pose challenges to general practice, NHS England has created a programme of work to support all English GP practices in developing their capabilities for online consultations. The Digital First Primary Care initiative sets out an expectation that all patients would have the right to online consultations from April 2020 – so what might this involve?
With funding also available from NHS England and further investment each year until 2022/23, GP practices can also make use of an extensive toolkit to help design and build a service that provides real benefits to patients.
What are the medicolegal risks?
While practices should be well underway with their plans and rollout, there is the unavoidable concern that with new technology comes new risks. Any endeavour that improves the provision of healthcare for both clinicians and patients has to be applauded, and at Medical Protection we can certainly see the value of providing online consultations where appropriate. There are clear advantages like greater access to care and reduced waiting times, while checking the identity of the patient is easier when the patient is already registered and may be known to the GP.
There are, however, inherent limitations with remote consultations, such as difficulties in spotting non-verbal clues and the inability to examine your patient. Triage becomes even more important in ensuring a virtual consultation is the right option.
With technology being the crux of the consultation, you need to be satisfied with the quality of the link, which of course is dependent on the equipment and internet connections of both users. A face-to-face consultation should be arranged in timely fashion, should it be a more appropriate channel.
Privacy and consent
You should also ensure the patient is comfortable and has appropriate privacy in the location they are in prior to starting the consultation. The consultation should be documented fully in the patient’s records and, if still images or any part of the consultation is to be recorded, then patient consent should be sought and care taken as to how and where they are stored. As with any remote prescribing it is important to follow GMC guidance, be satisfied that a face-to-face consultation is not necessary in the circumstance and ensure that appropriate safety netting and follow-ups are arranged.
Finally, it is important to consider the security of virtual consultations, and it may be wise to seek specialist advice to ensure that the system used is fit for purpose and meets information governance requirements. GPs should develop practice protocols to minimise these risks and ensure there is the ability to arrange face-to-face consultations and urgent consultations in the practice when necessary.
Notifying Medical Protection
As a member of Medical Protection, you do not need to notify us that you are using online consultations for UK patients registered with your practice (where you maintain the facility to see the patient face to face if required), as long as you follow all relevant legal and regulatory guidance (for example, the GMC and CQC requirements in England) and any guidance issued by Medical Protection.
Online consultations have no impact on your subscription rates, and this also applies if you are a locum or other healthcare practitioner in the practice. New technology nearly always brings new risks but, by applying the same safe approach to virtual care that you do to physical care, you and your patients can reap the benefits of these new advancements.