The GMC's 'Good medical practice' (2024) principles apply as much to remote consultations as to any other consultation. Doctors must:

obtain adequate patient consent
ensure patient confidentiality
keep contemporaneous notes
make an appropriate assessment of the patient's symptoms
communicate with other doctors to ensure continuity of care, especially when seeing people who may be registered with another GP
have appropriate indemnity in place for the work they do.

Consent and confidentiality

Before carrying out a remote consultation, it is important to obtain consent from the patient. You should inform them of any limitations of clinical assessment by remote consultation and any potential security risks associated with the consultation taking place via the internet.

It's also important to assess the patient's capacity to make decisions about any treatment proposed.

Be aware that certain aspects of communication such as non-verbal cues will be lost, which could lead to misunderstandings by the patient or healthcare professional.

You must ensure you carry out the consultation in an environment where you can maintain patient confidentiality. You may also wish to explain to the patient the importance of ensuring they are somewhere private, where details of the consultation cannot be overheard or seen by someone else.

Documenting consultations

Just as with face-to-face consultations, careful contemporaneous notes should be made of the discussion with the patient, any assessment and management plan.

If you plan to record the consultation, the GMC advises that you must inform the patient in advance and obtain consent. Tell the patient why you are recording the consultation, how it will be stored and for how long. Record details of patient consent in the records and remember the recording will form part of the patient's medical record, and should be treated in the same way as other medical records.

Ensure there are appropriate security arrangements in place when personal information is stored, sent or received electronically. NHS Digital has a Codes of Practice for handling information in health and care.

Meanwhile, GMC guidance on confidentiality says that if you're responsible for managing patient records or other patient information, you must make sure the records you're responsible for are made, stored, transferred, protected and disposed of in line with data protection law and other relevant laws.

You should also be satisfied that any members of staff you manage are trained and understand their information governance responsibilities.

Consulting patients without access to their records

If you do not have access to the patient's medical records, and have not previously seen the patient face-to-face, a careful assessment is paramount. You must also give the patient your name and GMC number if you're prescribing.

The importance of careful clinical assessment, communication, safety netting and documentation cannot be underestimated. You may need to justify a decision to consult with a patient remotely in the patient's best interests, safety and welfare, rather than convenience alone.

Back-up plan

Live telemedicine is dependent on the quality of the system being used.

For example, a poor, low quality connection for a video consultation could place severe limitations on your ability to observe the patient and interpret signs properly. It's therefore important that the audio-visual content of any consultation is of high quality to ensure that consultations are safe.

Even with the best will in the world, technology does go wrong, and doctors must ensure they have plans in place for a patient's treatment if the system fails.

The GMC advises that doctors must, where necessary, examine the patient in person, so there should be a system in place to arrange a face-to-face consultation where appropriate.

Indemnity

Common reasons for complaints and claims, such as a failure to adequately investigate symptoms, a misdiagnosis or initiating inappropriate treatment can happen whether a patient is seen face to face or remotely.

We're aware that doctors are continuing to consult with patients remotely by phone or video link, having moved from their usual face-to-face consultations during the start of the coronavirus outbreak. You don't need to inform the MDU that you're doing so unless you take on new work that you have not previously informed us about. To do this, email us at membership@themdu.com.

Conducting remote consultations

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