Viewpoint: Fine balance needed with remote consultations

BALANCE and timing are professional judgements that are not unique to medicine. Whether it's hitting a cricket or tennis ball, performing ballet or playing in an orchestra, it is only when the task is carried out with perfection that it appears so deceptively simple. Balance and timing are everything.

One major challenge for health professionals during the pandemic has been the increased use of remote consulting. Practice staff have relentlessly had to balance the choice between seeing an individual patient face to face – with the risk of otherwise avoidable cross infection – and the sometimes less satisfactory alternative of a telephone or video consultation.

Of the many issues faced by health professionals presently, remote consulting is perceived to be particularly stressful, as a recent MDDUS survey has confirmed:

• More than a third of GPs (37 per cent) report finding treating their patients by remote consultation very or extremely challenging.
• 43 per cent of family doctors have found remote consulting a source of stress in the second wave of the pandemic.
• Of GPs who report finding remote consulting challenging, nearly half of this group (46 per cent) said they didn’t have access to the tools they needed to confidently make decisions.

Another burden upon healthcare professionals during the pandemic is the sheer volume and range of guidance and directives that have been generated and circulated. Guidance is not uniform across the countries of the UK and may vary on a regional basis within the same country. Consequently, there has been a need to find a balance between overwhelming doctors with new information and providing them with the necessary tools to aid decision-making.

This dilemma was well illustrated in the recent publication by the General Medical Council (GMC) of its revised guidance Good practice in prescribing and managing medicines and devices (which comes into effect on 5 April 2021). This updated guidance aligns with the GMC’s long awaited Decision making and consent guidance, introduced in November 2020.

The GMC’s root and branch revision provides greater clarity throughout on remote consultations and remote prescribing (rather than in a short stand-alone section, as currently). This is appropriate and timely given that MDDUS identified the need for tools to support remote decision-making. However, in the interests of balance, MDDUS supported the intentional and modest delay in publication, whilst the effect of vaccination began to work through the population, with the cushion of a six-week familiarisation period.

MDDUS welcomes clarity on remote consulting and prescribing in the interests of its members and their patients. Key elements of the revised guidance include:

• GMC standards apply whether the consultation is remote or face to face. If the standard cannot be met, then the consultation mode needs re-evaluation.
• The most suitable mode of consultation should be agreed between the doctor and patient where circumstances allow.
• Consideration of where a remote consultation may not be appropriate, such as when there is uncertainty about a patient’s capacity to make their own decisions or where serious domestic factors may compromise the remote approach.
• Clarification of the safety factors a doctor should consider before prescribing when there is no access to the patient records.

Society generally welcomes the gradual return to normal life, but it seems likely that remote appointments – including clinical consultations – will remain a long-term feature, even if at a lower frequency than currently. Only time will tell how the balance between face-to-face consultations and remote consultations will pan out.

MDDUS has an interest in both minimising the risk of harm to patients and the risk of criticism of doctors. As a means of achieving that in a changing world, the GMC’s revised guidance is key.

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