Doctors urged to read new contract for remote consultations

The Federation of Independent Practitioner Organisations is recommending consultants to read the small print of a new Bupa contract for remote tele-consultations. Its co-vice chairman Mr Ian McDermott explains. 

The UK’s biggest private medical insurer, Bupa, has just released a new contract relating to new terms covering the delivery and billing of remote tele-consultations. Consultants are being sent the document and are being pressured to sign.

Unprecedented circumstances in which all doctors have found themselves during the pandemic has forced us to adapt and to make changes to the way we practice, to accommodate new rules and behaviours. 

The growth of tele-consultations in the NHS and independent sector is a good example of how working practices have evolved and become a regular and routine part of many doctors’ weekly work, albeit with its own challenges, pitfalls and limitations.

Some insurance companies have shown understanding and have supported doctors in delivering this service to their patients. Sadly, one – namely, Vitality – has chosen to reduce reimbursements for doctors providing tele-consults. 

This is regardless of the fact that tele-consults can be more difficult to conduct, may take longer than a regular face-to-face appointment, require additional administrative processes and time, and tend to incur the same administrative burden in terms of dictating, checking and sending out clinic letters.

13 pages of clauses

The new Bupa contract covers the terms by which it will ‘allow’ consultants to conduct and bill for tele-consults. This contract contains 13 pages of clauses and details, and it was emailed to some consultants earlier this month (November), followed by daily follow-up emails urging them to sign up via a quick and easy online e-signature system. 

However, regardless of whatever pressure might be exerted to try and to get consultants to sign up quickly, it is vital that they do actually read the contract in full so that they appreciate the full ramifications of what they might be signing up to.

The main points of note within the new Bupa contract are that:

  1. Informed consent has to be obtained from each patient in advance of conducting a tele-consult (instead of face-to-face), and this consent needs to be recorded in the patient’s medical records. Obtaining consent at the beginning of the tele-consult apparently does not suffice for Bupa.
  2. Remote consultations cannot be billed for if they are under ten minutes in length.
  3. The consultation time must be accurately recorded.
  4. The patient must be asked to consent for the doctor to make an audio or video recording of the consultation, and if consent is given, then the recording must be kept – somehow– within the patient’s records.
  5. Each consultant has to ensure that their medical negligence insurance policy does actually cover them for remote consultations.

New additional processes

This contract brings in new clauses and new stipulations that many consultants might potentially overlook or not fully understand. It stipulates new additional processes that have logistical, time, resource, cost and data protection issues: all of which need to be considered fully and carefully.

From a practical perspective, many consultants might not have the appropriate technology available to them to record and safely store large numbers of lengthy video files in a way fully compliant with the General Data Protection Regulations – and we are talking about what could well potentially end up being many hundreds of files with many gigabytes of data. 

The additional consent processes that are required also represent an important issue that requires further thought, planning, resources and time allocation.

Abuse the system

One can only assume that the decision to implement this new contract was perhaps an attempt to prevent a small cohort of unscrupulous doctors from taking advantage of the opportunity to perform high volumes of short and low-quality remote consultations, purely for financially-motivated reasons. 

It is to be hoped that the number of consultants who would actually abuse the system in this manner would be low. But, sadly, such individuals may exist. The large majority of doctors are, however, conscientious and honest. 

In the NHS and independent sector, remote tele-consults have offered a vital lifeline to many doctors and patients alike during the lockdown periods, and – acknowledging their potential limitations and negatives, as well as their benefit – it is very likely that remote consults will become a permanent part of our standard practice. 

Mr Ian McDermott

It is vital, however, that the full practical, logistical and legal implications of any formal contracts relating to tele-consults are fully understood and appreciated before any legally-binding contracts are signed.

We would strongly urge any consultant who has any queries or concerns about any of the clauses or terms within Bupa’s new tele-consultation contract to seek formal advice from their relevant trade union before actually signing.