Remote consultations (over the phone, via video link or online) are on the increase. So when is it safe to prescribe without meeting a patient face to face?
Following guidance is key as there are potential patient safety risks to consulting remotely. It's important to identify and manage those risks, and to recognise that remote consultations are not always the right choice.
Is a remote consultation appropriate?
"We welcome innovations in medical practice that enable good care for patients, and support the use of remote prescribing that follows our clear prescribing guidance used in consultation with a patient in person or online."
Charlie Massey - Chief Executive and Registrar of the General Medical Council
Good practice – key issues
Ensure that the medium you are using does not affect your ability to follow the law and our guidance. Consent and continuity of care are key issues to remember when you are advising or prescribing treatment for a patient via remote consultation.
- Give patients information about all the options available to them (including the option not treat) in a way they can understand.
- Tailor the information you give, and the way you give it, to patients’ individual needs, and check that they’ve understood it.
- If you’re not sure a patient has all the information they want and need, or that they’ve understood it, consider whether it is safe to provide treatment and whether you have valid consent
- You must ensure you can assess a patient's capacity. If a patient lacks capacity to make a decision, consider whether remote consultation is appropriate, including whether you can meet the requirements of mental capacity law.
Continuity of care
- If you’re not the patient’s GP, ask the patient for consent to get information and a history from their GP and to send details of any treatment you’ve 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.
If you are providing services remotely, remember to...
- Follow our guidance on consent and good practice in prescribing
- Work within your competence
- Check you have adequate indemnity cover for your remote consultation activities
- Discuss this element of your practice with your responsible officer at appraisal
Dr Best works for an online pharmacy, assessing patients’ requests for private prescriptions.
Dr Best reviews the questionnaire submitted by a 28 year old patient, Lauren, who has requested painkillers for acute back pain. Lauren has indicated that the pain was the result of an accident – she tripped and fell in the street.
Dr Best is concerned about the request since the painkillers Lauren has asked for are very strong. He also notes from the pharmacy’s records that Lauren has received the same medication for the same problem on three previous occasions. Dr Best is concerned that this may indicate an underlying issue – with the injury, Lauren’s pain management or possibly medicines misuse.
What should the doctor do?
- Prescribe the painkillers to help Lauren with her immediate pain, but tell her that next time she should see her own GP?
- Decline to prescribe and advise Lauren to seek face-to-face medical advice about her back problem?
- Contact Lauren asking for further information about her injury, current pain levels and previous prescription requests?
What the doctor did
As Lauren’s request was submitted online, Dr Best can’t discuss the request with her or carry out an examination. He also has limited opportunities for follow-up. As there is doubt about the cause of Lauren’s pain, which he isn’t able to resolve, Dr Best decides not to prescribe painkillers for her. He recommends that she make an appointment to see her GP or another doctor who can assess her condition and treatment needs appropriately.
What the doctor had to consider
- Remote consultations (online or via telephone or video link) can improve patient access to advice and treatment, but they are not always an appropriate alternative to seeing a patient face-to-face.
- When consulting remotely, it’s important to consider the limitations of the medium by which you are communicating with the patient. You should not prescribe unless you are satisfied that you have sufficient information to do so safely.