Changes imminent to GMC advice on remote consultations
New GMC guidance for doctors on remote consultations and prescribing is to be published soon. The GMC’s Mark Swindells reports.
On 18 February 2020, a month before the first lockdown, the UK had nine confirmed cases of Coronavirus. It was also the day we closed our call for evidence on remote consultations and prescribing.
That evidence was to help us decide if our existing guidance, last updated in 2013, had kept pace with changes in practice and in the use of technology.
We will publish our updated guidance early in 2021. It has been informed by the evidence we asked for and by what has happened in the months since.
During the year, the number of patient consultations delivered remotely increased dramatically across all four UK nations:
- In England, between February and April GP appointments conducted by phone more than trebled, from below 14% to almost half of all appointment types.
- In Northern Ireland, more than 14,000 video consultations were carried out between April and September 2020.
- In Scotland, the ‘Near Me’ service expanded from 300 to 18,000 video consultations each week and reached the half a million milestone by mid-November.
- In Wales, a new NHS Wales video consultation service is currently providing more than 1,000 consultations every week.
There are many obvious benefits of remote consultations, not least the reduction in the potential transmission of Covid-19. But it is important that we also monitor the experience for doctors and for patients.
As a regulator, we want to enable innovation which can benefit patients, help doctors and be safe. And updated GMC guidance will need to last beyond the current pandemic.
The future
With remote consultations and prescribing now a fixture in health services, there’s a need to ask questions about how doctors can ensure ethical standards are maintained when delivering care remotely.
Can new technology make it easier for some to self-manage long-term conditions?
Does it improve the experience for patients with sensory disabilities or risk creating barriers for them?
Is it possible to properly demonstrate practical things, like using an inhaler correctly, without face-to-face interaction?
Can a skin condition be accurately assessed without a physical examination?
While our current guidance speaks to individual doctors about the standards of good medical practice, we recognise that decisions like whether to consult face-to-face or remotely will often be influenced by local protocols and the availability of technology.
But one thing is clear – if a doctor can’t meet our standards using a remote consultation, they should switch to a face-to-face consultation instead.
Service design
Many doctors will also have roles in commissioning and influencing the design of these services. It is important they consider carefully how digital models can best support the two-way dialogue between doctor and patient, which goes to the heart of the traditional, trusted relationship.
For example, if online questionnaires are used to get information from a patient, it is crucial that the doctor can discuss issues and check facts with the patient and any other treating health professionals to prescribe safely.
Patients must also know whom to contact afterwards if they have any questions. Doctors working in systems where this is not possible have a duty to raise a concern.
Doctors must also be able to access a patient’s medical history, especially when prescribing controlled drugs which present a risk of addiction, misuse or overuse.
Private sector and sharing information
The pandemic has expedited system change to improve information-sharing within the NHS and with the independent sector, but there are still gaps.
We know doctors in both remote and face-to-face settings will sometimes find themselves in a position where they can’t easily access or verify the information they need to prescribe safely.
This raises serious questions. Should doctors be able to prescribe controlled drugs without access to medical records? In our view, this is only appropriate in an emergency, such as providing continuity of care until a patient can see their regular prescriber.
We will clarify our advice on information-sharing to be clear that if a patient objects to giving consent to share information with other treating health professionals, then it may be unsafe to prescribe.
It is, sadly, a matter of public record that coroners’ inquests have found that when these steps are missed, the consequences can be tragic.
We see our regulatory role as enabling innovation that benefits patients – in a safe way – while being conscious that our updated guidance must remain relevant long after the current pandemic has passed.
That guidance, building on the 2013 version and taking account all that has happened since, including the rapid changes this year, is coming soon.
Until then, the principles in our current remote consultations guidance remain, and are hopefully helpful in what continues to be a challenging time for everyone in healthcare.
Mark Swindells (right) is GMC assistant director for standards and guidance