Using remote consultations

The scenario

Paul, AOP member

“I’m a practice owner with a number of patients who are likely to be shielding for the foreseeable future. I’d like to get a strong system for remote consultations in place, for use when these patients are unable to visit the practice in person. I’d like more information on how I can ensure my record-keeping is effective during remote consultations, as well as how to communicate with patients in this way.”

The advice 

Roshni Kanabar, clinical and regulatory advisor at the AOP

Setting up the call

The GOC standards require registrants to communicate effectively with their patients, and this is especially important when giving advice remotely. You should set up your workstation in a private room, whether you are at home or at work, and make sure background noise is kept to a minimum. Ensure you are familiar with any software you are using before the call and, if possible, try to ensure you have access to the patient’s clinical records.

You should be aware of referral pathways in your area, and any temporary changes to these during COVID-19. Ensure you have useful telephone numbers to hand for the local hospital, pharmacies or other practices. It goes without saying that if you have arranged a specific time for the consultation, you should contact the patient promptly.

During the call

Introduce yourself and explain how the remote consultation will work. If you do not have access to the patient’s clinical notes, ask them to provide you with relevant background information. Don’t forget to record the patient’s contact details if you don’t already have them.

Patients may be nervous, especially if they are using remote consultations for the first time, so try to sound calm and confident as this will help to reassure them.

Ask detailed questions to ascertain any “red flag” symptoms, and try to build a clinical picture to help you manage the patient. It’s likely that your history and symptom taking will be more detailed than in practice, because you won't be able to perform most clinical tests remotely, and may not have access to the patient’s previous clinical notes.

Ensure patients receive advice on what to do if they notice any further changes after the consultation, and record this clearly. If the patient has a condition that can be self-managed, you should consider arranging a remote follow-up.

After the call

Wherever possible, send the patient a written summary of your advice and invite them to get in touch if they have any further questions, or experience any further problems. Also send extra information, such as leaflets on managing conditions or information about their referral, if applicable. The AOP has downloadable leaflets on this that could be sent to patients. When sending information, use a secure email wherever possible.

Keep a record of any patients who need following-up. If you have referred a patient for urgent investigations, contact the patient and/or service provider to ensure appropriate arrangements have been made within an appropriate timeframe.

Record keeping

Ensure you make a clear record of the patient’s symptoms, your discussions, and any advice given, including patient leaflets or referral letters that you are sending. Make it clear that this is a remote consultation, and if there are any special circumstances. Any email correspondence with the patient should be included and stored with the clinical records. We do not recommend recording the consultation unless you have fully considered all the complexities around this, and the patient has consented.

If you need to make written notes whilst working from home, file these away in a locked cabinet so that they remain confidential until you can take them to the practice. If you are making electronic notes, these need to be saved securely. Make sure there is a clear timeline of events for other practitioners to follow.