Covid-19 - Remote Consultations and IT
An agreement has been struck between NHSX, NHS Digital and Microsoft to enable all eligible organisations in England to access Microsoft 365 digital tools.
It secures access to a variety of Microsoft applications, building on an agreement first announced in April 2018 that enabled NHS organisations to use Windows 10 to strengthen their defences against cyber attacks.
The NHS Digital press release says "GPs, consultants, nurses, therapists, paramedics and support staff, will have access to services within Microsoft 365, ensuring they are able to use tools such as Microsoft Teams, which will enable staff to collaborate more effectively through instant messaging, audio and video calls".
As primary care moves to a total triage system, NHSE have produced a document with advice on how to establish a remote "total triage" model in general practice using online consultations. This document, works through the set up process including implementation within PCNs with resources for virtual eHubs. Appendix 1 also has practical guidance for reception staff managing the workflow. There is funded implementation support available to help with the roll out and effective use of these tools, so please do take advantage of this. Please contact your NHSE/I regional team or the NHSX Implementation Team to access this support.
There are a wealth of resources around remote triage and we have listed below some we feel are particularly useful.
The Principles of Safe Video Consulting
The RCGP have published guidance in conjunction with NHSE&I on the principles of safe video consulting in general practice.
One question that is frequently asked is " am I covered by the state indeminity" for video consulting. The Clinical Negligence Scheme for General Practice (CNSGP) covers all primary care services commissioned under a General Medical Services (GMS), Personal Medical Services (PMS) or Alternative Provider Medical Services (APMS) contract, where these services are provided directly or under a direct sub-contract.
• The location of the services and whether they are digital or face-to-face will not affect the cover.
• The particular solution used to provide the online or video consultation is not relevant to the scope of the scheme.
• All providers of NHS primary medical services will be eligible for cover under the CNSGP, including out-of-hours providers.
• The scheme will extend to all GPs and others working for general practice who are carrying out activities in connection with the delivery of primary medical services.
You will need to maintain membership with your medical defence organisation (MDO) in respect of activities and services not covered by CNSGP , eg medico-legal matters outside claims.
Examinations perceived to be intimate
Another frequent question is around examinations that may be perceived to be intimate on a video consultation. There is a detailed chapter in the RCGP/NHSE document that looks at this topic. Considerations around consent, both implied and explicit, mental capacity, chaperones all need to be considered and documented. As a general rule, remote intimate examinations should not be video and audio recorded and patients discouraged from sending images of intimate parts of their body. Updated to this, new guidance published in July 2020, is specific to the key principles for intimate clinical assessments undertaken remotely. It is aimed at clinicians who are consulting remotely with patients through a digital channel (e.g. online, email, text, video-link) across healthcare settings in England.
The principles described in this guidance aim to support patients to access care in a way that meets their needs and to support clinicians to provide care in a way that is in the best interests of their patients, whilst protecting both from the risks associated with remote intimate assessments.
The production of this guidance has also lead to amendments of legal guidance from the Crown Prosecution Service on indecent and prohibited images of children..
Trisha Greenhalgh, on behalf of the IRIHS research group at the University of Oxford has produced an excellent guide entitled Video consultations: a guide for practice . Within this are 4 handy one page guides to
- When is video appropriate?
- How can our practice get set up?
- How to do a high quality consultation
- A guide for patients on consulting by video
The BMA also has some advice and guidance on remote consultations and as practices now have to move to a triage first model for consultations, NHS England have developed a range of resources to help practices implement this approach.
E-LfH have a session module on Remote Triage in General Practice, this may also be helpful for any returning GP's to use as part of a refresher programme.
Watch this video by Dr Camilla Janssen for tips and tools on "Remote Paediatric Consulting"
With thanks to eGP learning for their useful resource entitled Quick Telephone Consultations Tips for Primary Care.
Take a look at our webpage for Electronic Prescribing Service (EPS) that also includes details for EPS in remote consultations.
Remote working - laptops
Annex A of the Letter 3 update from NHSE (updates during Covid-19) sets out the Digital Primary Care assistance available. We are advised that local commissioners should provide the equipment and support services necessary to facilitate remote working/triaging. If local commissioners are unable to respond either through lack of equipment or funding or both, we are advised that they will be supported nationally. Please note that any equipment used for access to clinical systems must conform with Securing Excellence in Primary Care: The Primary Care (GP) Digital Services Operating Model 2020-21 standards .
It is also important to keep in touch with all of the practice team and Microsoft Teams is an excellent resource for this (and used by your very own LMC!) NHSmail has been enabled to work with this programme and guidance on this is available here .
If problems are not sorted locally, please contact firstname.lastname@example.org .
At this time, practices will need to be able to send messages to patients in much greater volume than normal. Most areas already have unlimited SMS plans. For those that don’t and need additional credits for SMS messaging, they should urgently secure the additional capacity through their local commissioning groups. If your CCG needs additional funding to cover this, please ask that they contact email@example.com.
NHSX can be contacted for any queries around IT and Covid-19 at firstname.lastname@example.org