Working with doctors Working for patients

Remote patient consultations and prescribing

As a doctor, you may be asked to consult with patients, provide clinical advice and prescribe treatments without seeing the patient face-to-face. In some cases this may be without having any previous knowledge of the patient or an opportunity to physically examine them.

Remote consultations and prescribing by telephone, video link and online can present a number of risks to patient safety.

The standards set out in Good medical practice for patient consultations apply in all cases, whether or not you are face-to-face with a patient.

We provide additional specific advice on remote consultations and prescribing in Good practice in prescribing medicines and medical devices.

Working with our standards should help you ensure that patients receive safe care, whether they are based in the UK or accessing services from overseas.

Key guidance and resources

In development: In 2017, we are exploring patients’ experiences of online and video-linked consultations and prescribing, and approaches to safe remote consultation. We will update this page as this work progresses.

What Good medical practice says

Good medical practice (2013) sets out the general principles for ensuring that you make well-informed treatment decisions and provide safe care for patients – remotely or face to face. General principles for ensuring that you make well-informed treatment decisions and provide safe care for patients – remotely or face to face - are set out in Good medical practice (2013).

We advise doctors that:

14. You must recognise and work within the limits of your competence.

14.1 You must have the necessary knowledge of the English language to provide a good standard of practice and care in the UK.

15. You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must:

a. adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient

b. promptly provide or arrange suitable advice, investigations or treatment where necessary

c. refer a patient to another practitioner when this serves the patient’s needs.

16. In providing clinical care you must:

a. prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs

b. provide effective treatments based on the best available evidence

c. take all possible steps to alleviate pain and distress whether or not a cure may be possible

d. consult colleagues where appropriate

e. respect the patient’s right to seek a second opinion

f. check that the care or treatment you provide for each patient is compatible with any other treatments the patient is receiving, including (where possible) self-prescribed over-the-counter medications

17. You must be satisfied that you have consent or other valid authority before you carry out any examination or investigation, provide treatment or involve patients or volunteers in teaching or research.

What the Prescribing guidance says

Our guidance on prescribing for patients based on consultations by telephone, online and video link is set out in Good practice in prescribing medicines and devices (2013) [paragraphs 60-66].

While this guidance focuses on prescribing, it sets out good practice for carrying out any remote consultation.

We advise doctors that:

60. Before you prescribe for a patient via telephone, video-link or online, you must satisfy yourself that you can make an adequate assessment, establish a dialogue and obtain the patient’s consent in accordance with the guidance at paragraphs 20–29.

61. You may prescribe only when you have adequate knowledge of the patient’s health, and are satisfied that the medicines serve the patient’s needs. You must consider:

a. the limitations of the medium through which you are communicating with the patient

b. the need for physical examination or other assessment

c. whether you have access to the patient’s medical records.

62. You must undertake a physical examination of patients before prescribing non-surgical cosmetic medicinal products such as Botox, Dysport or Vistabel or other injectable cosmetic medicines. You must not therefore prescribe these medicines by telephone, video-link, or online.

63. If you are prescribing for a patient in a care or nursing home or hospice, you should communicate with the patient (or, if that is not practicable, the person caring for them) to make your assessment and to provide the necessary information and advice. You should make sure that any instructions, for example for administration or monitoring the patient’s condition, are understood and send written confirmation as soon as possible.

64. If the patient has not been referred to you by their general practitioner, you do not have access to their medical records, and you have not previously provided them with face-to-face care, you must also:

a. give your name and, if you are prescribing online, your GMC number

b. explain how the remote consultation will work and what to do if they have any concerns or questions

c. follow the advice in paragraphs 30–34 on sharing information with colleagues.

Continuity of care is a key patient safety issue where you are providing advice and prescribing treatment for a patient via remote consultation. The standards set out at paragraphs 30-34 of the Prescribing guidance will apply to these situations.

Benefits and risks of telephone consultation

Good telephone triage and consultations can improve patients’ access to advice and treatment. They can provide a safe alternative to a face-to-face consultation. But only where risks are recognised and effectively managed through service design and in the way that services are delivered.

Services such as NHS 111 and primary care providers are already making good use of telephone consultation to meet the growing public demand for faster access to good quality advice and care. If you provide telephone consultations, or make use of telephone consultation services to support your practice, you will need to have a good understanding of the patient safety risks and how to reduce and manage the risks to ensure patients receive safe care.

The Royal College of General Practitioners has published evidence-based practical advice in Telephone Triage and Consultation. Are We Really Listening? (2017). It is aimed at anyone developing services for, or directly involved in, assessing patients over the telephone whether in primary care, secondary care or any other clinical area.

Raising patient safety concerns

If you are working with an organisation providing remote advice and treatment services to patients we expect you to follow our guidance, and take account of organisational policies and procedures that ensure they can deliver a safe, effective standard of care.

If you are concerned that your organisation’s arrangements pose a risk to patients, as a doctor you have a responsibility to raise your concerns with those in a position to put the matter right.

If you are a doctor with leadership and management responsibilities in an organisation that provides remote services, you have a responsibility to ensure that patients can receive safe care and to act on any concerns brought to your attention. See paragraphs 19-22 of Raising and acting on concerns about patient safety.

For guidance on how best to raise or follow up on a concern, see:

Practical resources

Here are just a few resources that may help you to reflect on how to implement our guidance in practice.

Interactive case study: work through one of our short scenarios to understand how the guidance can apply in practice.’

>>Go to the case study

NHS Scotland e-prescribing - Health Improvement Scotland