As remote consultations become the norm, practice managers play a crucial role in adapting procedures to mitigate risks, staying compliant with evolving guidelines, and effectively addressing the rise in complaints
CREDIT: This is an edited version of an article that originally appeared on GP Online
In the evolving landscape of general practice, Dr. Ellie Mein, medico-legal adviser at the Medical Defence Union (MDU), underscores the need for practices to adapt their procedures for remote consultations, with a particular emphasis on ensuring timely face-to-face assessments for patients with persistent unresolved symptoms.
The three-strike rule
In the world of general practice, an age-old principle suggests that if a patient reaches out to the practice three times concerning the same issue, a referral should be contemplated—a strategy often dubbed the “three-strike rule.” Recently, this rule has found application in the realm of remote consultations, urging some practices to establish a threshold. After a series of remote consultations for a recurring issue, patients may be prompted to attend a face-to-face assessment.
Mitigating risks in remote consultations
The MDU has observed a surge in complaints and incidents stemming from delayed or misdiagnosed cases during repetitive remote consultations. As per the General Medical Council’s (GMC) revised guidance on Good Medical Practice, it is imperative for practices to adhere to specific guidance on remote consultations, ensuring compliance and risk management.
The NHS recorded a 37% surge in complaints against practices from 2018/19 to 2021/22. Among these, an escalating number relate to concerns that patients should have been seen in person sooner. Allegations frequently emphasise that an adverse outcome could have been averted through an in-person consultation.
Ethical considerations
Even predating the pandemic, debates surrounding the advantages and drawbacks of remote consultations in primary care were underway. The GMC’s updated Good Medical Practice underscores the ethical duty to deliver safe and effective clinical care, irrespective of the mode of consultation—be it face-to-face, via telephone, video link, or online services.
Learning from adverse incidents
In the aftermath of adverse incidents, practices are expected to reflect on their practice, extracting valuable insights to implement changes that prevent recurrence. An essential aspect of this reflection involves evaluating whether a remote review was clinically appropriate under the circumstances.
Setting thresholds for remote consultations
Addressing these concerns, some practices establish thresholds for the number of permissible remote consultations before recommending an in-person assessment—typically after two or three remote consultations for the same issue. While this approach offers a valuable prompt for reassessment, the nuances of each case demand a consideration of factors beyond rigid adherence to predefined thresholds.
Despite the conclusion of the pandemic’s peak, the enduring reliance on remote consultations necessitates ongoing risk management strategies for practice managers, as they navigate the intricate balance between the benefits and challenges presented by this new norm in healthcare delivery.
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