Q2: Considering that video consultations are likely here to stay, what is your perspective on how a GP practice should be managing the balance between offering video and face2face consultations.
JH – Unless the patient cannot get to the surgery, it is quicker and safer to conduct a f2f examination.
JL – The issue is that video examinations are being overused and used in areas where it is not safe to do so.
Video consultations are perfect for those where you clinically need to see the patient, such as requests for repeat prescriptions and for sick notes for patients with chronic problems that haven’t changes. Things that don’t require a face2face consultation.
Also, it is important to remember that the GP is there to provide a service to the public and so should be providing a service that is flexible and user friendly. There has to be a facility for those who can’t use technology. As an example, an elderly client may be disenfranchised from even calling the GP if they don’t necessarily have the tech skills to access the services online.
A GP practice needs to draw up protocols to ensure safety remains paramount. The primary question is “Can I be sure that the patient does not have a serious condition that I can only diagnoses with a face2face examination?” The most important role of the GP is to ensure they are not missing something which if left could have disastrous consequences for the patient.
As an Example of a recent claim I saw: An elderly patient calls with a very acutely painful leg. According to the GP, he asked her if it was hot, red or swollen and the lady replied to say that it looked entirely normal but that it really hurt. The doctor wrote in the notes that it was likely arthritis and subsequently it was discovered that this lady had an acutely ischemic leg and a serious vascular issue. Clearly this was a breach of duty as the GP could not have been sure of their diagnosis and did not follow up with a face2face consultation to clarify her condition.
TF – It is always a clinical decision based on the information available but once a remote consultation has started it may become clear that a face 2 face consultation is required and this should then be offered and recommended by the treating doctor.