Face to face and remote consultation models

Learning Objectives

By the end of this session, you will be able to:

• - Structure consultations

• - Understand different Consultation Models

• - Compare & contrast the Consultation Models

• - Explain GPhC Standards for providing pharmacy services at a distance

• - Select appropriate consultation method

Consultations

Definition: A professional interaction between patients and healthcare professionals for the purpose of patient care.

Preparation:

• Workspace/Consulting Area: Confidential, quiet, appropriate positioning

• Professional Attire

Consultation Structure:

1. Introduction

2. Body

3. Closing/End

Consultation: Introduction

• Introduce yourself and your role.

• Confirm patient identity.

• Confirm location (important for remote).

• Safety check (e.g., driving, abroad – follow guidance).

• Golden Minute: Build rapport and set the tone.

• Observe visual cues (if applicable).

Consultation: Body

ICE: Explore Ideas, Concerns & Expectations.

Gather Information / History Taking:

• Presenting Complaint (PC)

• History of Presenting Complaint (HPC)

• Previous Medical History (PMH)

• Drug History (DH)

• Family History (FH)

• Social History (SH)

Examination:

• Clinical images/photos (remote)

• Physical examination (if face-to-face)

Findings: Summarise key points.

• Options: Discuss possible management.

• Counselling: Provide information and advice.

Consultation: Closing/End

• Check understanding: e.g., “Can you explain back to me what we discussed?”

• Opportunity for questions.

• Plan: Agree next steps.

Safety netting:

• What to do if symptoms worsen, change, or don’t improve.

• Red flags and side effects.

• Who to contact / actions to take.

• Expectations: e.g., how long to see improvement.

• Signposting to other services.

• Referrals if needed.

Consultation Models

1. Face to Face

2. Remote:

• - Telephone Consultation (audio only)

• - Virtual Consultation (via internet, audio only)

• - Video Consultation (video + audio)

• - (‘Written’ consultations – e.g., online forms, chatbots)

Benefits of Different Consultation Models

• - Patient-centred care

• - Increase accessibility & patient choice

• - Reduce exclusion

• - Hybrid working flexibility

• - Staff recruitment advantages

• - Virtual: Can share links/resources easily

Benefits Compared: Face-to-Face vs. Remote

Challenges Compared: Face-to-Face vs. Remote

Considerations When Selecting Consultation Method

• - Two-way communication possible?

• - Consent obtained and documented?

• - Mental capacity assessed?

• - Confidentiality maintained?

Can all required information be gathered?

• - Assessments/tests

• - Examinations

Can all required information be provided?

• - Counselling

• - Resources

Patient’s needs considered?

Medicines liable to misuse?

Person at risk of death or serious harm?

When to Consider Remote Consultations

• - Straightforward need/request

• - Patient able to provide all required information

• - Access to patient’s medical records

• - Patient has capacity

• - No physical examination needed

• - Monitoring can be self-reported (e.g., BP, weight, height)

When Face-to-Face is Preferable

• - Complex clinical needs

• - Unable to ascertain all information remotely

• - No access to Patient Medical Record (PMR)

• - Questions about patient capacity

• - Physical examination required / high-risk condition

• - Diagnostic test required

GPhC Standards: 5 Principles for Pharmacy Services at a Distance

Principle 1:

The governance arrangements safeguard the health, safety and wellbeing of patients and the public.

• - Risk Assessment

• - Regular Audit

• - Accountability – clear staff roles

• - Record keeping

Principle 2:

Staff are empowered and competent to safeguard the health, safety and wellbeing of patients and the public.

• - Trained and competent staff

Principle 3:

The environment and condition of the premises from which pharmacy services are provided, and any associated premises, safeguard the health, safety and wellbeing of patients and the public.

• - Premises suitability

• - Digital Platform security and accessibility

Principle 4:

The way in which pharmacy services, including the management of medicines and medical devices, are delivered safeguards the health, safety and wellbeing of patients and the public.

• - Transparency and choice

• - Managing medicines safely

• - Supplying medicines safely

• - Information for pharmacy users

Principle 5:

The equipment and facilities used in the provision of pharmacy services safeguard the health, safety and wellbeing of patients and the public.

• - Specialist equipment and facilities maintained and fit for purpose

QUESTIONS:

Part 1: Single Best Answer (SBA) Questions

1.

During the opening stage of a consultation, which action is most critical for building rapport and setting a positive tone?

a) Immediately begin gathering the patient's medical history.

b) Use the "golden minute" to introduce yourself, confirm safety, and observe visual cues.

c) Discuss treatment options to show your expertise.

d) First obtain written consent for the consultation.

Answer:

b) Use the "golden minute" to introduce yourself, confirm safety, and observe visual cues.

The initial moments are crucial for establishing trust and a collaborative atmosphere. The "golden minute" involves introductions, safety checks, and initial observation, which lays the foundation for an effective consultation.

2.

According to the GPhC standards for pharmacy services at a distance, which principle requires that staff are "trained and competent" to provide remote services safely?

a) Principle 1: Governance arrangements

b) Principle 2: Staff competence

c) Principle 3: Environment and premises

d) Principle 4: Service delivery

Answer:

b) Principle 2: Staff competence

Principle 2 specifically states: "Staff are empowered and competent to safeguard the health, safety and wellbeing of patients and the public." This directly translates to the need for specific training and competency assessments for remote consultations.

3.

A patient requests a remote consultation for a repeat prescription of a stable medication. They are technologically literate and have no new symptoms. When is it generally appropriate to proceed remotely?

a) When the patient is unable to travel due to work commitments.

b) When a physical examination is required to assess efficacy.

c) When the patient's capacity to consent is in question.

d) When the request is straightforward and all necessary information can be gathered and provided remotely.

Answer:

d) When the request is straightforward and all necessary information can be gathered and provided remotely.

Remote consultations are suitable for straightforward needs where the patient can provide all required information (e.g., stable medication review), no physical exam is needed, and counselling/information can be effectively delivered remotely.

4.

What is a key advantage of a face-to-face consultation over a remote one when assessing a patient with a possible respiratory infection?

a) It is more convenient for the working population.

b) It allows for a physical examination (e.g., auscultation).

c) It reduces the risk of digital exclusion.

d) It is easier to share digital links and resources.

Answer:

b) It allows for a physical examination (e.g., auscultation).

A primary clinical advantage of face-to-face consultations is the ability to perform a physical examination. For a suspected respiratory infection, listening to chest sounds is a key diagnostic step that cannot be done remotely.

5.

During the closing stage of a consultation, what does "safety netting" specifically involve?

a) Summarising the patient's medical history.

b) Providing written information leaflets.

c) Advising on what to do if symptoms worsen or do not improve, including red flags.

d) Confirming the patient's identity and location.

Answer:

c) Advising on what to do if symptoms worsen or do not improve, including red flags.

Safety netting is a critical component of the consultation close. It involves giving the patient clear, actionable instructions on when and how to seek further help, ensuring they are not left unsupported if the initial plan fails.

Part 2: Extended Matching Questions (EMQ) Set

Questions 6-10:

For each consultation scenario described, select the MOST appropriate consultation model or primary consideration from the options below.

Options:

A. Face-to-face consultation is strongly preferable.

B. A remote (video/telephone) consultation is likely suitable.

C. Principle 1 (Governance) of the GPhC distance standards is the key concern.

D. Principle 4 (Service Delivery) of the GPhC distance standards is the key concern.

E. The "Body" stage of the consultation, specifically exploring ICE (Ideas, Concerns, Expectations), is the immediate priority.

6.

A patient with well-controlled hypertension requests their annual medication review. They are comfortable using video calls and can self-monitor their blood pressure at home.

Answer:

B. A remote (video/telephone) consultation is likely suitable.

This is a straightforward, monitoring-based consultation for a stable condition. The patient can provide necessary data (BP readings) remotely, and no physical exam is required, making remote delivery appropriate.

7.

An elderly patient presents with new, unexplained bruising and fatigue. They have a complex drug history including anticoagulants. They seem slightly confused during a brief phone call.

Answer:

A. Face-to-face consultation is strongly preferable.

This is a complex, potentially high-risk presentation (possible bleeding, confusion). A physical examination is needed, capacity may be impaired, and a full assessment is difficult remotely. Face-to-face is essential for safety.

8.

A pharmacy is launching a new online minor ailments service. The superintendent pharmacist is developing protocols to ensure clear staff roles, audit procedures, and accountability for decisions made during remote consultations.

Answer:

C. Principle 1 (Governance) of the GPhC distance standards is the key concern.

Principle 1 focuses on the overarching governance framework: risk assessment, audit, accountability, and record-keeping. Developing these protocols is a direct application of this principle.

9.

A patient using a pharmacy's app for a prescription request is concerned about how their personal health data will be stored and who will have access to it.

Answer:

D. Principle 4 (Service Delivery) of the GPhC distance standards is the key concern.

Principle 4 includes the requirement to provide clear "Information for pharmacy users." This scenario relates to transparency about data use and security, which falls under this principle's mandate for clear communication in service delivery.

10.

During a consultation for recurrent migraines, the patient appears anxious and repeatedly says, "I'm just worried it's something more serious like a brain tumour."

Answer:

E. The "Body" stage of the consultation, specifically exploring ICE (Ideas, Concerns, Expectations), is the immediate priority.

The patient is explicitly voicing a deep concern. Effective consultation requires exploring these Ideas, Concerns, and Expectations (ICE) to address the underlying anxiety and tailor the management plan appropriately.

Part 3: Clinical Scenarios (OSCE/Patient Style)

Scenario 1: Selecting the Consultation Method

A 25-year-old university student contacts the pharmacy via an online form requesting treatment for acute diarrhoea they have had for 36 hours. They report no fever, blood in stool, or recent travel. They ask for a next-day delivery of loperamide.

What are the key considerations in deciding whether to manage this request remotely or require a face-to-face consultation?

* Suitability for Remote: The request is straightforward (common, self-limiting condition). Key safety information (duration, absence of red flags like fever/blood) can be gathered via the form. Counselling on rehydration and when to seek help can be provided in writing or via a follow-up call.

* Red Flags for Face-to-Face: You must consider if all required information is present. The form must explicitly rule out other red flags (e.g., recent antibiotic use, abdominal pain, pregnancy). If any doubt exists, or if the patient cannot be contacted for clarification, a face-to-face assessment would be safer to exclude more serious causes.

* GPhC Principle Application: This engages Principle 4 (Service Delivery). The process must ensure the patient receives all necessary information (safety netting advice) and that the medicine (loperamide) is supplied safely, considering contraindications.

Scenario 2: Structuring the Close of a Consultation

You have just completed a telephone consultation for a patient starting a new topical corticosteroid for eczema.

Summarise the key elements you would include in the "Closing/End" stage of this consultation.

* Check Understanding: "To make sure I've explained everything clearly, could you tell me how and when you plan to apply this cream?"

* Opportunity for Questions: "What questions do you have for me before we finish?"

* Agree Plan: "So, the plan is to apply a thin layer once daily for the next 7 days as we discussed."

* Safety Netting: "It's important you know what to watch for. If the skin becomes more irritated, swollen, or infected (hot, pus-filled), stop using it and contact your GP. If there's no improvement after a week, please come back and see us."

* Expectations: "You should start to see less redness and itching within a few days."

* Signposting: "Here's the link to the National Eczema Society website for more self-management tips."

Part 4: Application of GPhC Principles

Question 11: Principle in Practice

A pharmacy uses a third-party video platform for consultations. Under GPhC Principle 3 (Environment and premises), what are two specific checks the pharmacy owner must ensure are in place?

Answer:

1. Digital Platform Security: The platform must use appropriate encryption to ensure patient confidentiality and comply with data protection laws (e.g., UK GDPR). It should be a dedicated, secure service, not a consumer-grade app.

2. Accessibility & Suitability: The platform and the physical location from which staff conduct calls (e.g., a back office) must ensure confidentiality (no overhearing), be professionally appropriate, and have reliable technology (good audio/video, internet connection) to safeguard the consultation quality.

Question 12: Contrasting Challenges

A patient with low digital literacy needs a medication review. Compare one key challenge of conducting this review remotely versus one key challenge of conducting it face-to-face for this patient.

Answer:

* Remote Challenge (Digital Exclusion): The primary challenge is access and skills. The patient may lack a device, internet, or the confidence to use video software. This could prevent the consultation from happening or compromise its quality if they struggle with the technology, potentially breaching the principle of accessibility.

* Face-to-Face Challenge (Logistics): The primary challenge is accessibility due to travel. The patient may have mobility issues, lack transportation, or live in a rural area, making it physically difficult and time-consuming to attend the pharmacy, potentially leading to missed care.