In light of COVID-19, the NHS is turning to remote consultations in order to minimise the risk of infection for staff and patients.
In England, Matt Hancock said ‘we have moved to a principle of digital first in primary care and with outpatients, unless there are clinical or practical reasons, all consultations should be done by telemedicine.’
The roll out of video consultations was also announced in Wales and Scotland.
The following guidance is intended to support doctors in any healthcare setting to conduct remote consultations.
Advice for GPs
Practices must now move to a triage first model for consultations. NHS England have developed a range of resources to help practices implement this approach. Practices in other nations are also moving towards this model.
Practices are asked to use telephone, video and online consultations to support triage and remote management of patients.
In particular, you are encouraged to promote online consultations to patients and introduce this service where they don’t already have it. Video consultations should be used where possible, however, telephone access will be used where there are barriers to digital access.
The NHS is exploring other enablers for remote working to such as:
- single sign-on
- sharing of records across the system
- electronic generation of forms
- creating virtual workspaces and secure interfaces without the need for laptops/VPNs.
Read further guidance for locum doctors on working remotely.
Read further guidance on managing long term conditions remotely.
National roll-out of tools and equipment
Issuing laptops for primary care
In England, 9,522 additional laptops have already been deployed with another 13,000 approved for distribution.
Where this has not happened and where additional equipment is urgently needed, local commissioners are asked to provide the equipment and support services.
Any equipment used for access to clinical systems must conform with these standards.
Video consultation tools for primary care
If your practice is in England and you do not have a videoconferencing solution in place, contact your commissioner so that one can be provided to you.
In Wales, work is ongoing to appraise and, where appropriate, roll out commercial products, such as AttendAnywhere, AcuuRx and other software designed for this purpose.
For Scotland, boards are rolling out Near Me in order to increase update of remote consultations.
Video consultation tools for secondary care
To help accelerate the uptake, NHS England and NHS Improvement have procured 12-month licences for Attend Anywhere. These licences will be available free of charge to all NHS secondary care providers.
£20,000 of capital funding is available to support NHS secondary care providers who are using video consulting to purchase any hardware they need.
NHS England and NHS Improvement have produced a range of support materials.
When working from home, the advice of NHSX for England is that personal equipment can be used where there is no practical alternative.
- ensure your internet access is secure
- ensure account control if others could get access to your equipment (ie use a discrete account login)
- use a strong password
- communicate using tools that use encryption
- not store confidential patient data on the device unless it is absolutely necessary and appropriate security is in place.
Accessing your clinical system
If you are a GP, please see the NHSX guidance on how you can access your systems remotely.
Check with your clinical systems provider for the latest information and practical advice around remote working.
VPN tokens are necessary to establish secure connections to NHS networks from remote sites.
NHS England are working closely with clinical system suppliers and NHS Digital to ensure they can increase the supply of tokens for you. NHS Digital has now established a process for GPs to claim from a pool of 30,000 tokens. Their preference is for soft tokens, which would be delivered to you electronically.
You will need a smartcard for certain functions on clinical systems such as EPS and e-RS. NHS Digital has begun distributing additional smartcards and has procured a virtual smartcard solution so that remote working can be supported.
Communicating with colleagues
NHS organisations now have free access to Microsoft Teams which provides instant messaging, direct audio and video calls between NHS colleagues and has virtual meeting capabilities.
Ensuring a video consultation is appropriate
The standards expected of doctors by the GMC and the ICO apply equally to digital and conventional consultations.
The appropriateness of remote consultations should be reviewed carefully for patients whom capacity may be of concern. Where family members, carers or relatives use online consultations on behalf of the patient, you must ensure consent has been obtained.
The GMC has produced a flowchart to help practitioners to decide when a remote consultation is appropriate.
Is video better than telephone?
Clinicians should choose the medium that is most appropriate for them and their patient.
Video may be appropriate for when:
- you are self-isolating or working remotely
- the patient is a known Coronavirus case or is self-isolating
- the patient has Coronavirus symptoms
- the patient needs reassurance
- the patient is in a care home with staff on side to help.
Things to consider:
- does videoconferencing work on the device?
- do you (and your patient) have the right equipment ie microphone, speakers/headphones, webcam?
- do you have a back-up option?
- getting the patient's phone number in case there are technical difficulties so you can phone them
- sufficient bandwidth to conduct video consultations (there are known issues with this and the BMA is seeking solutions).
NHS England have produced a guide for doctors (and patients) on carrying out a video consultation during COVID-19.
Tips for conducting a consultation
- Get to know the equipment and ensure you have a good connection.
- Avoid disturbances.
- Check sound and video quality.
- Ask if the patient can hear/see you.
- Use active listening.
- Make eye contact – this may not be possible if making notes so tell the patient if this is the case.
- Pick up on cues.
- Offer opportunities to ask questions.
- Summarise and repeat back.
- Advise on next steps.
- Document well.
- Take regular breaks.
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