Video consultation

There are a number of ways in which video consultation can be used, and it is probably easiest to start with the simplest first, and build on this, as everyone becomes more skilled in using this medium.

Although video consultation can be used free of charge, a number of CCGs and trusts have decide to purchase ‘Skype for Business’, which seems to have some benefits for organisations.

Multidisciplinary Team meetings There are many situations where employees work at some distance from a centre, and spend considerable time travelling for meetings with colleagues. Being able to use video consultations can mean a considerable saving in time and resources. As with telephone conferences, it takes a bit of practice to join in when other people are speaking, as it is more difficult to use non-verbal prompts to let others know when you want to speak. So the success of a video meeting depends on a chairperson’s inclusiveness when conducting the meeting.

Using video consultation with patients:

Before beginning to use video consultation with patients, there are a number of issues that need to be resolved: there needs to be a Privacy Impact Policy (a copy of one is in our resources section), a Standard Operating Procedure, and clarification of medical indemnity – this means contacting the company who provides your medical indemnity, and confirming with them that they will continue to provide cover for these consultations which are not the usual face-to-face situation. Agree with them any limitations on how you can safely practise using video consultation. Make sure the arrangements in your clinic or surgery will support what you want to do. The hardware must be suitable – are you going to use a tablet/i-pad, or a webcam? How will you be able to access the patient’s record during the video conversation? Make sure that Skype has been enabled by the local IT provider. You should initiate the video call. Have you got a system for arranging appointment times when they will be called? Have you let it be known what kinds of appointments are suitable for video consultations?

GP to hospital consultant -This may be a useful means to better understanding between hospital consultants and GPs, where willing consultants are keen to provide this service. When a GP finds a complex patient who would benefit from the specialist knowledge of a secondary care specialist, being able to have a conversation with a consultant, while the patient is present in the surgery, could be a useful learning experience for the GP, and help the patient by saving a hospital attendance, and by starting treatment earlier. The practicality may be that the consultant agrees specific times when he or she will be available for video appointments, but video consultation offers an opportunity for the consultant to see the patient being discussed, without a need for a separate hospital appointment, and to ensure that treatment in the community is as effective as if it had been started in a hospital setting.

GP /nurse to care home/nursing home. – Although being able to use video consultations is likely to save many visits to nursing and care homes, and therefore considerable clinician time, these appointments are likely to be only part of the service provided, with face-to-face consultations still common. Homes are only likely to agree to the use of video consultations if they understand that it is an alternative in some situations, and that they will not lose contact with the GP practice. Once they realise that it is easier to have a video consultation than to arrange a GP visit, staff begin to understand that they are supported better, and are more prepared to look after patients who previously might have been sent to A&E. At the end of life, being cared for in familiar surroundings, rather than a busy, impersonal hospital ward is the most appropriate place to be, and Skype can help to realise this goal. By using Skype via wi-fi on an iPad or tablet, the patient can remain in their own room, and not need to be taken to an office where the broadband input is located. It is important that the video consultation is regarded as any other doctor’s visit, and while it might be agreed for a member of staff to be present to help with the process, it would not be possible for the consultation to continue if unexpected visitors came into the room.

Direct video consultation GP / nurse to patient This is an area which is likely to develop in the near future, as patients want to be seen more quickly or conveniently. For this, you need patients to ask to be eligible for this service, and sign a consent form, which will include guidance as to what a suitable condition for a video consultation is. You will need to have a list of bookable video consultation appointments, and make it clear that you will contact them at an approximate time. The patient should be resident in the UK at the time of the video call, as you would not be able to predict what other drugs or services could be available if the patient were to be in a different country. Although there is unlikely to be a great deal of time saved by having a video consultation (although it does appear that conversations are more focused when using this) the patients will probably welcome the option, and it is likely that there will be less missed appointments.