Video Consultation Policy

Introduction

Remote consultations provided online, over video-link or by phone can benefit patients, save resources and help meet public demand for more convenient access to healthcare. 

A large body of research has been conducted by the Oxford University and the General Medical Council in relation to the safe use of Video Consultations in primary practice. This policy is based principally on the findings of research, which has been done in hospital outpatient settings, and suggests that video consultations using modern technologies appear broadly safe for low-risk patients.

Policy Statement

This guidance outlines practical information about delivering remote consultations and other ways of remote working.

The coronavirus pandemic creates an urgent need to increase remote working across the health and care system to prevent the spread of the virus.

GPS Health Online will seek to use remote video consultations as far as reasonably practicable to meet the needs of our patients.

Scope

A remote consultation is an appointment that takes place between a patient and a clinician over the telephone or using video, as opposed to face-to-face.

Using remote consultations supports GPS Health Online to more effectively manage patient care and also supports the coronavirus response by:

 - preventing the transmission of the disease by reducing the need for patients to travel into the clinic

 - allowing GPS Health Online clinicians to speak to patients who are unable to travel to the clinic (e.g. patients in at risk groups, or due to self-isolation or travel difficulties)

 - allowing GPS Health Online clinicians to carry out clinical work from a remote area (e.g. staff in at risk groups, or due to self-isolation or travel difficulties)

 - supporting GPS Health Online to meet a wider range of patients.

Procedures

The GPS Health Online app can be downloaded for free directly to your own mobile phone enabling the patient to manage their own accounts.

The patient can take and upload photos and maintain a symptom diary for themselves.

They are able to share this with any dermatologist, consultant or medical practitioner, to seek further treatment and advice, including GPS Health Online if they so choose to follow up on their skin condition.

Remote Consultations:

We are able to provide online remote consultations using the documentation from the app, in relation to symptoms, images and any videos taken, to be able to carry out a consultation with the client.
If during the online video conference consultation, it is deemed necessary to have a face to face appointment with the patient then we can arrange a face to face follow up appointment at the clinic.

Consent

 - We will give patients information about all the options available to them (including the option not to treat) in a way they can understand.

 - We will tailor the information we provide, and the way we give it to patients' individual needs, and check that they've understood it.

 - If we are not sure a patient has all the information they want and need, or that they've understood it we will consider whether it is safe to provide treatment and whether we have valid consent can assess a patient's capacity.

 - If a patient lacks capacity to make a decision, we will reconsider whether remote consultation is appropriate, including whether we can meet the requirements of Mental Capacity Law.

Continuity of Care

 - Ask the patient for consent to get information and a history from their GP and to send details of any treatment you have arranged.

 - If the patient refuses, 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.

 - Make record of your decision and be prepared to explain and justify it if asked to do so.

Risks associated with remote consultations.

There are potential patient safety risks in using remote video conferencing, particularly due to limited access to a patient's medical records.

Patients can expect to have effective safeguards in place to protect them when they receive advice and treatment remotely from GPS Health Online.

Safeguards are necessary whether the consultation happens in the context of a continuing treating relationship or is a one-off interaction between a patient and a GPS Health Online healthcare professional.

Monitoring

In providing services remotely we will

 - Follow the General Medical Council guidance on consent and good practice in prescribing.  - At GPS Health Online all clinicians are encourage working within their competence.

 - Have adequate indemnity cover for remote consultation activities.

 - If in doubt about the content of this policy, discuss this element of your practice with your responsible officer at appraisal.

How to do a high-quality video consultation

Steps Guidance

Before the consultation

 Confirm that (as far as you can assess in advance) a video consultation is clinically appropriate for this patient at this time

 - Use a private, well-lit room and ask patient to do the same

 - Take the patient's phone number in case the video link fails

 - Ensure you have access to the patient's clinical record (ideally, have it available on a second screen)

 - On the day, check that the technology is working

Before the consultation

 Confirm that (as far as you can assess in advance) a video consultation is clinically appropriate for this patient at this time

 - Use a private, well-lit room and ask patient to do the same

 - Take the patient's phone number in case the video link fails

 - Ensure you have access to the patient's clinical record (ideally, have it available on a second screen)

 - On the day, check that the technology is working

Starting the consultation

Initiate the consultation by calling or inviting the patient

 - Say something e.g. "can you hear me?" "can you see me?" to prompt patient to optimise the technical set-up

 - Take and record verbal consent for a video consultation

 - Introduce everyone in the room (even those off camera), and ask patient to do the same or confirm that they are alone

 - Reassure the patient that the consultation is likely to be very similar to a standard one, and that the call is confidential / secure

Having a video consultation

Video communication works the same as face to face, but it may feel less fluent and there may be glitches (e.g. blurry picture)

 - You don't need to look at the camera to demonstrate that you are engaged. Looking at the screen is fine

 - Inform the patient when you are otherwise occupied (e.g. taking notes or reading something on another screen)

 - Make written records as you would in a standard consultation

 - Be aware that video communication is a bit harder for the patient

Closing the consultation

Be particularly careful to summarise key points, since it's possible something could have been missed due to technical interference

 - Ask the patient if they need anything clarified

 - Confirm (and record) if the patient is happy to use video again - To end, tell the patient you're going to close the call now, and say goodbye (before actually closing the connection)

KEY PRINCIPLES FOR VIDEO CONSULTATION

We expect GPS registered healthcare professionals to follow ten high level key principles when providing remote consultations and describing remotely to patients based in the UK

1 Make patient safety the first priority and raise concerns if the service or system they are working in does not have adequate patient safeguards including appropriate identity and verification checks.

2 Understand how to identify vulnerable patients and take appropriate steps to protect them.

3 Tell patients their name, role and (if online) professional registration details, establish a dialogue and make sure the patient understands how the remote consultation is going to work.

4 Explain that:

• They can only prescribe if it is safe to do so.
•   It's not safe if they don't have sufficient information about the patient's health or if remote care is unsuitable to meet their needs.
• It may be unsafe if relevant information is not shared with other healthcare providers involved in their care.
•   If they can't prescribe because it is unsafe they will signpost to other appropriate services.

5 Obtain informed consent and follow relevant mental capacity law and codes of practice.

6 Undertake an adequate clinical assessment and access medical records or verify important information by examination or testing where necessary.

7 Give patients information about all the options available to them, including declining treatment, in a way they can understand

8. Make appropriate arrangements for after care and, unless the patient objects, share all relevant information with colleagues and other health