Date published: 15 January, 2024
Date last updated: 11 March, 2024
Digital, General practice

Video consultation tools

Version 1.2, 12 June 2023

This guidance is part of the Online patient facing services section of the Good practice guidelines for GP electronic patient records.

Video consultation tools form part of  the Digital first online consultation and video consultation (DFOCVC) framework and the core digital offer for primary care. 

Amendments to the GMS and PMS regulations mean that all practices within England must offer video consultations to their patients.

Video consultations (VC) provide patients with greater choice and flexibility, offering remote and secure appointment options in real-time, through the use of a smartphone, tablet, or computer. VCs can be a separate tool from the online consultation (OC) tool or be a feature offered as part of the OC tool.

Features

Patients and clinicians can connect to each other using a secure link generated by the VC tool and sent to the patient via SMS (text) or email. 

In their simplest form, VC tools allow a:

  • secure video conference platform for the clinician and the patient
  • secure voice communication pathway for the clinician and the patient

The ability to hear or see the patient will, however, depend on the equipment used by the patient and the consulting clinician.  VC tools can also provide some advanced features to help with this:

  • automatically enabling both users (clinicians and patients) to configure their sound and video settings through pop-ups or instructions
  • asking users to test their sound and video equipment before the consultation
  • virtual waiting rooms for a user whilst waiting for the consultation to start
  • chat function through a messaging application within the platform to help when there are sound or other technical issues
  • alerts for either user when the internet connection is poor to help them identify the problem
  • ability to toggle the camera and/or microphone on or off

Advantages and pitfalls

Advantages

The advantages of VC tools over traditional telephone consultations include:

  • noticing visual cues unavailable over the telephone
  • improved rapport with patients
  • potential for multi-disciplinary team (MDT) or multi-stakeholder video consultations
  • use of virtual ward rounds for nursing homes
  • ability to carry out video-specific examinations and assessments
  • potential for video group consultations for chronic disease management and health promotion
  • improving the consultation experience for housebound patients
  • improving access for certain patient groups who struggle with face to face consultations but want a more personal approach beyond telephony
  • helping to pick up extra information during the consultation process

Potential pitfalls

The potential pitfalls include:

  • dependency on the hardware set up for the patient and the practices
  • dependence on a good internet connection
  • digital exclusion for groups that find the use of technology daunting or financially prohibitive
  • reduced examination potential compared to face-to-face consultations.
  • technical issues that stop the flow of the consultation
  • lack of confidence by clinicians in carrying out video consultations
  • perceived lack of value of video consultations over telephone consultations

The British Journal of General Practice: Video Consultations article provides further information on the benefits versus disadvantages of video consultations.

Organisational maturity

Despite early adoption during the COVID-19 pandemic, video consultations make up a small minority of remote consultations in primary care.  There are several reasons for this, even with the number of enabling factors within the healthcare system.  Video consultations can, however,  be a powerful medium when consulting with patients.  Continued uptake will only happen if practices empower their users (clinical, non-clinical and patients) to do so.  If you are interested in increasing the use of video consultation tools you will find the related article on ‘Remote consulting tools | Procurement, regulations, governance and transformation‘ helpful.

Start by assessing current organisational maturity and readiness levels by asking the following questions:

  • Do we have clear communication and engagement strategies for patients to explain, educate and empower them in the use of video consulting?
  • Do we have on-going communication and educational strategies for clinicians to build their confidence in video consulting?
  • Have we created a process that allows our care navigators or receptionists to understand what is suitable for video consulting?
  • Do our front-line staff know how to book and create a planned/unplanned video consultation in our systems that patients and clinicians can access successfully?
  • Can we confidently say all the equipment we have in place for video consulting works, is operational and present in consulting rooms?
  • Can we or are we auditing the use of video consulting in our local environment and learning from trends or possible opportunities?
  • Do we have the right policies and protocols in support video consulting?
  • Have we considered using video group consultations and do we understand what they are?

Preparation for video consulting

Practices will need to ensure the correct hardware and software is tested and reliably working for video consultations to support ongoing use.  Equipment can be procured directly from suppliers or by working closely with local commissioners/supply frameworks.  Figure 1 below is a summary of how to prepare for a video consultation


Figure 1: Preparing for video consultations (Oxford University video consultation guide)

Clinicians may also decide to work from home.  Practices using VC tools for consulting should check the following when staff carry out video consultations from home:

  • Do they have the correct equipment and hardware?
  • Does their equipment meet the risk assurance standards of the practice and wider NHS standard?
  • Can they connect to the Health and social care network (HSCN) and NHS identity service to securely carry out video consultations?
  • Do they have a space to carry out video consultations confidentially?
  • Do they have a stable and fast internet connection to carry out video consultations from home?
  • Has the practice provided a policy on home working?
  • Do clinicians have a clear understanding of emergency management protocols and escalation procedures during an emergency?
  • Do their contracts require amendment for regular remote working?
  • Have they carried safe working practice assessments for home working?

Medicolegal and clinical governance considerations

Practices must ensure their training, implementation process, standard operating policies, and procedures are up to date to support video consulting.  Detailed information on the above can be found in the Remote consulting article in this series.

The table below summarises the main points when implementing video consulting:

Table 1: Policy, protocols and assessments in video consulting

 

Policy/standard operating procedure/ assessments

 

Key considerations

Consent
  • Consent is implied by patients accepting the video consultation as a mode of consultation and entering the video consultation. Screenshots and/or recordings of the consultation must only happen if there is a justifiable reason to do so and with prior informed consent by the patient or someone with the legal authority to act on their behalf.  Consent should be sought from the patient if an interpreter/team member or trainee is joining the consultation. During the examination, it may be appropriate to ask third parties to leave the consultation (* please see intimate examinations below).
  • Video group consultations will need further considerations regarding informed consent and the Future NHS web portal (log in needed) has a dedicated section to help practices with this. 

Confidentiality
  • Clinicians must carry out video consultations in a room that can maintain the privacy and confidentiality of the patient throughout the consultation. This is no different to face-to-face or telephone consultations.

Capacity
  • Video consultations may not be appropriate for patients who lack the capacity to make decisions unless they are supported by another health professional or representative acting on their behalf, and the video consultation is in their best interests.

Adult and child safeguarding
  • Adult and child safeguarding policies apply to all methods of remote consulting.  Policies should reference this and provide additional guidance detailing how to pick up signs during a video consultation and subsequent escalation processes.

Did not attend (DNA) Was not brought (WNB) policy 
  • DNA and WNB policies need to reflect new types of consulting, including pre-arranged video consultations. Follow up calls may be appropriate as a lack of response may indicate a technical difficulty or failure.

Emergency management
  • Staff should know how to manage emergencies during a video consultation in the event this occurs live during a consultation.  They should be confident in escalating such emergencies when working within the practice or from home.

Clinical safety risk assessment
  • Practices will need to carry out risk assessments on the use of new digital tools or health IT being used to deliver remote consultations as per the DCB 0160 standards.

Data protection impact assessment

Intimate examinations and chaperoning
  • Guidance on examining patients through video consultation platforms should be shared with staff.  This must include specific advice on why intimate examinations should rarely be carried out over video consultation platforms.
  • See Intimate Examinations and Video Consulting (RCGP)

Prescribing

Health and safety
  • Policies should reflect desktop configurations considering webcam and telephony use.  Policies may need updating to reflect health and safety when working from home.

Remote working
  • Practices may need to create remote working policies if allowing working-from-home set-ups when using video consultations.

Video consulting
  • Video consulting policies should be created to aid and guide staff.

Empowering patients

Patients will have varying levels of understanding and confidence with video consulting.  Using engagement channels directly through the practice, social media, or via targeted messaging campaigns can be helpful.  

Patients may have several questions regarding the use of video consulting. Common questions may include:

  • Is a video consultation appropriate for me?
  • How do I prepare for a video consultation?
  • Will the clinician be able to hear and see me?
  • Can I have a physical examination in a video consultation?
  • What happens if I need to be seen face-to-face after the video consultation?
  • Is the video recording stored anywhere?
  • Can anyone else see or hear what is happening during the consultation?
  • Can I bring a relative, friend or guardian to the video consultation?
  • What happens if the system stops working? Will somebody still call me?

The Nuffield Department of Primary Care and Health Science has created useful guides for patients including a quick guide for patients including a section on frequently asked questions.   There is also guidance for service users on the NHS England website.

Empowering clinicians and staff

Where possible, practices should create or share training guides on video consulting with their staff.  This includes information explaining the limitations of video consulting and its safe use.  

Video consultations work best when they are integrated into the overall practice approach to consulting with patients.  For example:

  • Video consultation may be the natural outcome after a patient’s online consultation request has been triaged by an appropriately trained team member.
  • Patients may request a video consultation as their preferred method of communication and assessment.
  • Care home leads may coordinate a multidisciplinary video conference for their complex care home patients with the care of the elderly and community frailty teams.
  • Hormone replacement therapy (HRT) nurses may use video group consultations to educate patients on HRT prior to sending out patient-specific questionnaires to aid in information gathering.
  • A telephone consultation may be switched to a video consultation during the triage or a previously planned telephone consultation to aid decision-making.
  • Clinicians may request a video consultation with a patient after reviewing a clinical image provided by a patient and completing an online consultation request to help gain further clarity.
  • Diabetic nurses may deliver health promotion symposiums for their patients on how to manage their insulin levels effectively.

There are several accredited training guides on video consulting to help clinicians (see below).  Staff can also attend training courses or complete e-learning to develop their confidence.  

Deciding which patients suit a particular consultation type is covered in detail in the Remote consulting and Digitally enabled triage articles in this series.

NHS England has published a set of graphical guides to video conferencing for staff and for patients.

Related GPG content

Other helpful resources

Date published: 15 January, 2024
Date last updated: 11 March, 2024