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Digital-first primary care: How to avoid potential risks of providing remote services

Digital-first primary care: How to avoid potential risks of providing remote services

Even before COVID-19, plans were in place for GP practices to provide online and video consultations. Yet adoption of digital technologies was slow. The pandemic changed that, dramatically accelerating the shift to remote consultations as practices reduced the risk of infection for staff and patients. Within weeks, under a quarter of consultations were face-to-face.

GP practices now triage and treat patients remotely wherever possible, via telephone, video and online messaging. Fortunately, clinicians report numerous benefits: flexibility for self-isolating staff and patients, reduced waiting times, greater collaboration, increased efficiency and better prioritisation, all improving satisfaction for patients and staff alike.

While the vast majority of GPs are positive about digital-first care, the speed of change may have left many with questions about potential medico-legal pitfalls.

So how should you safeguard patients’ interests and mitigate any risks of delivering remote care?

Is remote consultation in the patient’s best interests?

The General Medical Council (GMC) provides a flowchart to help clinicians decide if it is safe to treat a patient remotely or if a face-to-face consultation is in the best interests of the patient.

If you are confident that clinical need outweighs any concerns, consider the benefits, potential risks and patient preferences for different communication channels. Keep in mind that some patients feel anxious about online or telephone consultations and establish back-up plans in case of technical issues. Ensure that you can follow the law and GMC guidance using the chosen medium.

How does good medical practice apply in digital-first care?

As for all patient consultations, apply GMC’s principles of good medical practice to remote interactions.

Obtain adequate patient consent: Provide information about all the options, tailored so that individual patients can understand it. Allow sufficient time for the patient to digest the information. Check that they have capacity to understand and make decisions.

Ensure patient confidentiality: Establish that you are speaking with the right person. Check that the patient is ready and in a private space. Make sure that you cannot be overheard. Wherever possible in remote consultations, use a secure system approved for clinical use.

Communicate with other doctors to ensure continuity of care: If you are not the patient’s GP, seek the patient’s consent to obtain and send details of their medical history.

Keep accurate notes about remote patient care: Document that the consultation was remote and make adequate record of your decisions. Be prepared to explain and justify decisions if asked.

Is it appropriate to use photographs and video consultations?

Using photographs and video consultations is appropriate if it supports clinical decision making. Indeed, GPs and patients have increasingly used these during the pandemic, especially photographs.

GMC provides ethical guidance. Important points:

• Only ask for images if essential to support clinical decision making
• Use secure systems for storing and transferring images
• Seek informed consent

• Clearly explain why an image or video consultation is needed, and how it will be kept secure.

Is it safe to conduct intimate examinations remotely?

Carefully consider whether intimate examination is clinically necessary. In some cases, it may be more appropriate to examine the patient in person.

If you and the patient decide to proceed with remote examination, follow GMC’s key principles. Ensure you:

• Offer a chaperone wherever possible
• Use caution when requesting and storing intimate images
• Consult relevant laws and consider safeguarding issues for vulnerable people.

What special considerations apply to remote consultations with children and young people?

Safeguarding the health and wellbeing of children and young people is a priority. If intimate images are required for clinical decisions, follow relevant laws and local policies. Seek advice from your medical defence organisation.

The Royal College of Paediatrics and Child Health provides information on safeguarding in remote consultations.

What advice is there for remote prescribing?

Charlie Massey, Chief Executive and Registrar of GMC: “We … support the use of remote prescribing that follows our clear prescribing guidance.”

GPs should be aware of potential risks and follow GMC’s high level principles for good practice in remote consultations and prescribing. Allow adequate time for patients to understand prescribing information.

Practices should ensure that systems are in place to:

• Identify patient behaviour that raises concern, such as attempts to access potentially harmful medicines
• Monitor patients with long-term conditions

Top Tips for remote consultations

For top tips, visit the Royal College of General Practitioners guidance and Roger Neighbour’s Ten Tips for Successful Video Consultations.

NHS England provides resources to help practices implement the triage-first approach and video consultations. The British Medical Association also offers advice on tools for video consultations and home working.

Remember…

• Follow GMC’s guidance
• Take practical steps to mitigate risks to patient safety
• Check your indemnity cover is adequate for remote consultation activities

For advice about your remote consultation activities, contact Medical Defense Society.