Guidance for appropriate use of telephone and video consultations in general practice
Choosing to offer video consultation or telephone services
The GP and practice team will need to:
- determine work flows and system changes for the practice
- determine what technology platforms will be used
- set up and test any technology that will be used
- consider any training requirements for GPs and practice staff
- decide on a communication strategy for patients and other stakeholders associated with the practice
- update the practice website and/or on-hold messages to advise that telephone and/or video consultations are available
- provide patients with information on what to expect during their telephone or video consultation
- ensure patients are informed about the option to continue attending the practice for consultation if this is clinically appropriate and safe for the patient, practice staff and the community.
Decisions about whether or not the practice will offer telephone or video consultation services should be made by the GP and the general practice team. When making the decision to offer telephone or video consultations, careful consideration should be given to:
- deciding/agreeing on what appointments will be conducted via telephone or video consultation
- clinical effectiveness/appropriateness
- clinical needs of patients
- patient safety, including an existing relationship between the GP or general practice and the patient
- reliable and secure equipment, fit for clinical purposes
- secure management of patient health information
- patient experiences.
When to use a telephone or video consultation
Telephone and video consultations can generally be used for:
- any condition/scenario where a telephone or video consultation protects vulnerable populations, such as older patients and patients with comorbidities who are at increased risk if they do contract COVID-19
- medical certificates or issuing repeat prescriptions for medicines
- mental health consultations, counselling and similar services
- routine chronic disease check-ups, especially if the patient is stable and has monitoring devices (if required) at home
- any consultation where the trade-off between attending in person and staying at home favours the latter
- COVID-19 related conditions – refer below to ‘Telephone and video consultations related to COVID-19’.
There is no need to use video if a telephone call will suffice. The decision to offer a video consultation should be part of the wider system of triage offered in your practice. It should be understood that the addition of visual images via a video link adds value to any telehealth consultation and can improve both quality and safety for more complex consultations.
For some patients, a video consultation may be more appropriate than telephone – for example, where the patient is hard of hearing or deaf, a video consultation will provide them the opportunity to lip read. Video consultations allow GPs to view patients, which can assist in wound management and reviews and may assist in determining if they look unwell, given there is no opportunity to undertake a physical examination.
When not to use a telephone or video consultation
The RACGP acknowledges that while video or telephone consultations are generally not ideal for the following circumstances, the GP may need to exercise a judgement as to the balance of risks of a physical examination.
The RACGP recommends that video or telephone consultations should generally not be used, and arrangements made for an in-practice face-to-face consultation:
- for assessing patients with potentially serious, high-risk conditions requiring a physical examination, particularly for patients with chronic disease who are unable to selfmonitor appropriately and patient groups deemed high risk for poor outcomes from COVID-19
- when a physical/internal examination is required/cannot be deferred to support clinical decision making
- where a patient’s ability to communicate by telephone or video consultation is compromised and they do not have a support person to assist them during the consultation, impacting clinical quality and patient safety
- in situations where there is any doubt about the clinical appropriateness of a telephone or video consultation (in these instances, attending the practice in person for a faceto-face consultation is preferable).
Telephone and video consultations related to COVID-19
For issues related to COVID-19, telephone and video consultations should be used when:
- the clinician is self-isolating or is vulnerable due to their age or medical conditions
- the patient is self-isolating or is vulnerable due to their age or medical conditions
- the patient or clinician is a confirmed COVID-19 case or is self-isolating
- the patient or clinician has symptoms that could be due to COVID-19 and the use of telephone or video consultation protects the community more broadly
- the patient is well but anxious and requires additional reassurance from their usual GP or general practice
- the patient is in a residential aged care facility with staff on hand (as required) to support a telephone or video consultation
- there is a need for remote support to meet increased demand in a particular locality (eg during a local outbreak when staff are unwell).
How to manage and send clinical paperwork (prescriptions, referrals and requests) following telephone and video consultation
The current COVID-19 situation has presented challenges regarding the current systems and processes for sending and receiving clinical paperwork following telephone or video consultations. At this time, the RACGP recommends using the simplest and most effective methods for provision of prescriptions, radiology and pathology requests and other clinical referrals for patients in the interests of care continuity.
The RACGP recognises that email is currently not standard practice for electronic communication of clinical paperwork due to risks of interception. In these current, unprecedented circumstances, and with the increasing use of telephone and video consultations, the RACGP views email as an appropriate method of communication to ensure continuity of care, providing it adheres to RACGP guidance on using email in general practice and informed consent is obtained from the patient to use email (fully understanding the risks of interception). This informed consent should be documented in the patient’s health record.
Prescriptions can now be sent directly to patients via SMS or email using electronic prescribing. Read more about electronic prescribing and access fact sheets for GPs and patients on the RACGP website.
Patients can also arrange to pick up a paper prescription from the practice, or have a family member or support person pick it up on their behalf.
eRequesting of pathology and diagnostic imaging is a process that transfers requests from general practice clinical information systems (CIS) directly to the pathology or diagnostic imaging provider via secure electronic communication. Your general practice can now participate in eRequesting if your local clinical information system is set up to do this and you refer patients to providers who can receive eRequests. Read more about eRequesting on the RACGP website.
If you are unable to eRequest, or if the patient would like a paper request to take to a different provider, the patient can also arrange to pick up the request from the practice, or have a family member or support person pick it up on their behalf.