Not being in the same room as the patient creates barriers to communication, making it more difficult to discuss symptoms or provide advice. And without the opportunity to closely examine the patient, there might be a greater fear of  missing a diagnosis.

The media regularly covers failures in remote consultations, which have led to serious harm or death. For example, the BBC reported that more than 100,000 had signed a petition calling for mandatory face-to-face GP appointments following the death of a woman from cancer who had been misdiagnosed over the telephone. 

In the US, a woman sued telehealth provider Amazon One Medical after her husband collapsed and died shortly after a video consultation. She alleged the clinician had failed to recognise the severity of his symptoms or tell him to seek urgent care.

 
Concerns have also been raised by UK regulators. Most recently, the Health Services Safety Information Body (HSSIB) investigated the patient safety risks posed by online consultation tools, which patients use to make requests and seek health advice from their practice. Its report found, “a small number of reports to prevent future deaths which referenced remote care, including online tools,” adding that safety incidents were likely to be under-reported. 

Concerns raised in the report included the limited clinical information provided to clinicians, the design and implementation of online consulting tools and patients’ ability to use them.  

The pandemic and the NHS’s Digital First model for primary care accelerated the use of remote consulting, which has prompted the NHS and regulators to produce guidance for practices and healthcare professionals. 

Here’s a selection below, but this is a fast-moving area so keep checking the relevant websites for updates.

• NHS England’s good practice guidance on online patient facing services includes sections on online consulting, video consultations and digitally enabled triage. 
• NHS England’s ‘Key principles for intimate clinical assessments undertaken remotely in response to COVID-19’ is still relevant and covers safeguarding vulnerable patients, chaperones and the safe transfer of intimate images.
• NHS Scotland has a remote consulting learning site for health and social care providers.
• In Wales, Healthcare Education and Improvement Wales (HEIW) has produced high level principles for remote consultations and the government-funded Technology Enabled Care (TEC) Cymru provides resources and training on video consultations.
• The Care Quality Commission (CQC) covered online and video consultations in its GP mythbusters series, including the sharing and storage of clinical images. 
• For healthcare professionals, the GMC created an ‘ethical hub’ of relevant guidance, including a flowchart to help determine whether a remote consultation is appropriate in a given situation. In addition, the regulators (including the GMC, GDC and NMC) have co-authored ‘High level principles for good practice in remote consultations and prescribing’, which is intended for health prescribers with prescribing responsibilities.
• The MDU produced a guide to conducting remote consultations, and journal article explore the topic in more depth. 

Offering remote consultations, either as part of your service or as an online provider, will be popular with many patients and can help optimise efficiency. 

However, it's important to be on top of practice technology, procedures and safeguards so you can safely provide remote consultations and ensure patients can easily access care in person if they need to.

Here are our eleven must-haves.

1. Invest in IT that’s up to the job
Talk to an IT specialist about the minimum system requirements for your remote consultation service, including broadband speed. You may also need to invest in hardware (webcams, microphones and speakers) and software such as secure messaging and care pathway navigation that integrates with your existing electronic records. 

The NHS Toolkit on online consultations in general practice includes pointers on systems and procurement, but it’s your responsibility to ensure your chosen supplier is able to provide the necessary training and support and complies with data protection regulations. 

2. A clear appointments policy 
Update your practice policy to ensure it covers all appointment types, including how patients can book or cancel these and information about when remote appointments may not be in their best interests. 

When someone books a remote consultation, it makes sense to share information in advance about how the process works to avoid delays and missed appointments. For example, explain what equipment they’ll need and how to use the system. 

3. A secure way for patients to share personal information and images
Review your data protection policy and procedures to ensure you’re taking the appropriate steps to protect patient confidentiality with added safeguards for intimate images or those of child patients (as described in the NHS key principles). 

Provide a secure way for patients to send information and images electronically – for example, setting up an account for online services with two-factor authentication. 

Explain to patients that they need to protect their own privacy during remote consultations by ensuring they can’t be overheard or seen and using a private connection, rather than public Wi-Fi. 

4. An effective triage system 
This will make it easier to prioritise urgent cases, allocate them to the right member of the team and allow sufficient time for the consultation. 

However, it’s essential to provide proper training and support for non-clinical staff so they can identify and flag concerning symptoms or circumstances to the duty clinician. 

That might include the use of care navigation templates to manage patient requests, as well as supervision by their manager.

5. A protocol for obtaining and recording patient consent 
Remote consultations should take place only with informed consent, which means explaining the limitations of this type of appointment and warning patients that they may still need to attend in person. 

It’s a good idea for the practice to send this information in advance, but doctors can also check they have understood at the start of the appointment. 

When asking for consent to record consultations, you’ll need to explain why, how the recording will be stored securely as part of their medical records and for how long.

6. Training for healthcare professionals 
While remote consultations are becoming normalised, they can be challenging and not everyone will find it easy to adapt. It’s therefore in the interest of the practice to provide additional training which would typically cover areas like making a clinical assessment (with or without access to the patient records), communication and records.  

For example, NHS England’s e-learning for healthcare has a ‘remote consultations’ programme that’s free to NHS staff and available to non-NHS organisations for a fee. 

7. Contingency planning for where a remote consultation isn’t appropriate 
If the technology goes wrong or the doctor decides they need to physically examine the patient, it’s important for practices to have a system where patients can be booked in for an in-person appointment with minimal delay. 

With potentially serious conditions, it’s important to record the advice given about accessing urgent care. It’s also a good idea to have a system in place to flag and follow up with the patient.

8. A chaperone policy 
If the patient requires an intimate examination, it might indicate that an in-person appointment is more appropriate. However, your practice chaperone policy should be updated to cover this situation so you can offer the patient a trained chaperone from the healthcare team, who should be visible to the patient throughout. 

See the MDU guide to chaperones for general advice. 

9. Remote prescribing protocols 
Remote prescribing is only appropriate for some drugs and treatments and some patients, so make sure your prescribing protocol sets out clear parameters that are in line with relevant GMC safe prescribing guidance. 

There must also be a contemporaneous record showing:

• the clinician has assessed the patient’s needs
• their reasons for prescribing a particular medication
• their discussion with the patient 
• arrangements for follow-up and monitoring. 

Computer prescriptions should meet BNF guidelines and there should be safeguards in place for controlled drugs. Finally, injectable cosmetics shouldn’t be prescribed on the basis of a remote consultation. 

10. A system to ensure continuity of care
It might be necessary to contact the patient’s own GP for further information or clarification. The outcome of a consultation should also be shared with them (as well as other healthcare professionals involved in providing care). 

If the patient is reluctant to give consent for this, discuss their concerns and explain the possible consequences. If they continue to refuse, the clinician will need to decide whether it’s safe to provide treatment and make a record of this decision.

11. Appropriate indemnity arrangements
Check that the clinicians you contract or employ have adequate and appropriate professional indemnity to carry out remote consultations (this will be the case if they are MDU members). 

In addition, MDU Connect provides tailored insurance cover for private telehealth businesses. Email us or ask your broker if you’d like to know more. 

As an MDU Connect policy holder, you and your team have access to expert medico-legal and dento-legal guidance and support. 
We encourage you to address issues early to pre-empt problems, so contact us for specific advice or explore our resources. 

This page was correct at publication on 10th March 2025. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.