Over the past 11 months GP practices have been instructed to adopt a 'total triage' system, and to use video, online and telephone consultations wherever appropriate. This resulted in face-to-face consultations dropping to around 25% of all appointments delivered at the end of June 2020.
Good practice in prescribing and managing medicines and devices sets out the GMC’s standards for good practice when prescribing remotely and face-to-face, and for when patient care is shared with another doctor.
It comes as medical defence organisation the MDU revealed an increase in doctors wanting advice about prescribing remotely during 2020 - advising its members to ‘proceed with caution’.
Prescribing guidance
The guidance, which will take effect from Monday 5 April, includes updates for clinicians faced with prescribing remotely more frequently. Clinicians are advised not to prescribe controlled drugs unless they have access to patient records, except in emergencies.
There is stronger advice on information sharing, making it clear to clinicians that if a patient refuses consent to share information with other relevant health professionals, it may be unsafe to prescribe.
Clinicians are also alerted to the importance of good two-way dialogue between patients and doctors in all settings, aligning with the GMC’s updated Decision making and consent guidance.
The guidance emphasises the point that the same standards remain when prescribing remotely as they do when seeing a patient face-to-face, such as being satisfied that an adequate assessment has been made, establishing a dialogue and obtaining the patient’s consent.
Remote consultations
It also has specific advice for doctors prescribing remotely with patients in nursing homes or hospices, and patients who are based overseas; concerns which have been raised by MDU members in recent months.
Professor Colin Melville, GMC medical director and director of education and standards, said: ‘We understand the particular pressures GPs face as the pandemic continues and the vaccination programme is rolled out across the UK.
‘GPs are increasingly using remote technology, but the principles of good practice apply whether a consultation is face to face or by phone or video. We hope this guidance will support GPs as they continue to care for their patients in these incredibly challenging times.’
Concerns around remote prescribing have led doctors to seek advice from the MDU during the pandemic. In a recent survey conducted by the group, 97% of respondents said they had increased their use of phone consultations, while 75% conducted more video consultations.
Workload dumping
MDU head of advisory services Dr Caroline Fryar, said: ‘Prescribing as part of a remote consultation is often entirely safe and reasonable as long as the prescribing doctor has enough information about the patient, can make an adequate assessment and have a proper dialogue with the patient.
‘However, as ever, doctors need to apply their judgment and remain alert to situations in which a face-to-face consultation may be needed. Prescribing to patients overseas presents ethical and legal difficulties for doctors, who need to consider whether they have appropriate registration and indemnity among other considerations.’
GPs warned last November that they were being asked to prescribe drugs ‘we have no experience in managing’ by hospitals, who were accused of dumping work on their primary care colleagues during the peak of the first coronavirus wave.
This week a Medical Protection Society (MPS) poll revealed that over three quarters of GPs fear the COVID-19 pandemic will leave them facing investigations triggered by factors outside their control.
