Induction and training
It is essential that you are able to access a full induction with the provider. This should include all aspects of work you will be expected to do. It is also worth noting that induction is work, and that you should be paid for this time.
It is important that you are confident with the use of any proprietary IT systems. If you are working remotely check if there is immediate IT support available.
There may be specific matters arising from online work that need to be managed differently than traditional General Practice.
For example, when ‘time is up’ what recourse is there for the doctor to impart any additional essential information i.e. appropriate safety netting.
Another provider specific concern is how to mitigate limitations arising from the format of the consultation. For example, strategies for how to get adequate information without being able to examine a patient in person and where the limitations for this lie.
Access to Medical Records
Ensure you have access to medical records and consent to use them.
It is important to understand what information will be available to you during consultations with patients and in particular, if you will have access to their full medical records.
This is likely to be different when treating NHS patients or private patients and will vary depending on the provider and the arrangements that they have in place.
The BMA believes that it is important for one doctor, usually the patient’s GP, to have a complete record of the individual’s healthcare.
You should ensure that there are processes and systems in place to record explicit patient consent to share information with their GP and that you are satisfied that your obligations under the
GMC’s good medical practice to share information are met.
Policies and Procedures
Every organisation operates differently and when working with an online provider you should be able to access a similar range of policies and procedures as you would expect to find in NHS General Practice.
However, these may have a different focus than in the NHS and you should familiarise yourself with these and be sure of your roles and responsibilities and the providers.
You should be aware of and satisfied with policies and procedures relating to the following:
- Child and adult safeguarding
- Escalation protocols if unwell patients are identified
- Prescribing processes, local formularies and guidance on high risk drug prescribing
- Data Protection
- Information Governance, including privacy and confidentiality policies
CPD and professional and pastoral Support
Before agreeing to working for an online provider, it is important that you understand what pastoral support is available to you through the organisation.
Things to consider are:
- What processes and systems of support are in place to facilitate debriefs following a difficult consultation?
- What peer support or review is available for clinical dilemmas?
- Is there provision and support for CPD, and are you remunerated for this?
It is inevitable that from time to time errors occur and it is essential that you are aware of and satisfied with the clinical governance systems in place for you to raise concerns, be part of any investigation of significant events and have support if complaints are made against you.
Working for online providers means that traditional support and communication channels are not available which has the potential to result in professional isolation.
For information on how to avoid this and other issues, refer to the BMA Locum GP handbook