COVID-19 creates an unprecedented situation. Many GP practices are considering introducing video consultations as a matter of urgency to reduce risk of contagion.

This summary covers the following questions:

1. When are video consultations appropriate in primary care?

2. How can a GP practice get set up for video consultations?

3. How can a clinician conduct a high-quality video consultation in primary care?

4. How should patients prepare for, and participate in, video consultations?

For information on research evidence for the quality and safety of video consultations, please refer to the full guideline.

When is video appropriate?

There is no need to use video when a telephone call will do. The decision to offer a video consultation should be part of the wider system of triage offered in your practice. Patients who just want general information about COVID should be directed to a website or recorded phone message. But video can provide additional diagnostic clues and therapeutic presence.

Below are some rules of thumb, which should be combined with clinical and situational judgement.

COVID-related consultations: video may be appropriate when:

  • the clinician is self-isolating (or to protect the clinical workforce)
  • the patient is a known COVID case or is self-isolating (e.g. a contact of a known case)
  • the patient has symptoms that could be due to COVID
  • the patient is well but anxious and requires additional reassurance
  • the patient is in a care home with staff on hand to support a video consultation
  • there is a need for remote support to meet increased demand in a particular locality (e.g. during a local outbreak when staff are off sick).

Non-COVID-related consultations: video may be appropriate for:

  • routine chronic disease check-ups, especially if the patient is stable and has monitoring devices at home
  • administrative reasons e.g. re-issuing sick notes, repeat medication
  • counselling and similar services
  • duty doctor/nurse triage when a telephone call is insufficient
  • any condition in which the trade-off between attending in person and staying at home favours the latter (e.g. in some frail older patients with multi-morbidity or in terminally ill patients, the advantages of video may outweigh its limitations).

On the basis of current evidence, we suggest that video should not generally be used for:

  • assessing patients with potentially serious, high-risk conditions likely to need a physical examination (including high-risk groups for poor outcomes from COVID who are unwell)
  • when an internal examination (e.g. gynaecological) cannot be deferred
  • co-morbidities affecting the patient’s ability to use the technology (e.g. confusion), or serious anxieties about the technology (unless relatives are on hand to help)
  • some deaf and hard-of-hearing patients may find video difficult, but if they can lip-read and/or use the chat function, video may be better than telephone.

Setting up and conducting video consultations

Algorithms 1 and 2 provide information on how to set up and conduct video consultations. Algorithm 3 provides information for patients on consulting GP practices via video. 

RCGP Video consultations Algorithm 1

Algorithm 1—Video consultations in primary care: how can our practice get set up? Download a PDF of this algorithm.

RCGP Video consultations Algorithm 2

Algorithm 2—Video consultations in primary care: how to do a high-quality consultation. Download a PDF of this algorithm.

RCGP Video consultations Algorithm 3

Algorithm 3—Video consultations in primary care: a guide for patients on consulting by video. Download a PDF of this algorithm.

Full guideline available from:

www.rcgp.org.uk/policy/rcgp-policy-areas/-/media/B2ED99A2DBEE424788E12D17FF73A55F.ashx

Professor Trisha Greenhalgh, Professor of Primary Care Health Sciences, University of Oxford, and the Nuffield Department of Primary Care Health Sciences.Video consultations: information for GPs. 2020.

First published: March 2020. 

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