Face To Face & Remote Consultation Models
Ground Rules
Interact: Engagement is encouraged in discussions.
Listen Attentively: Concentrate on the content and the speaker.
Make Notes: Document essential points for later review.
Professionalism: Maintain a professional demeanor throughout the session.
Respect Each Other: Foster a respectful learning environment by valuing each participant's contributions.
Learning Objectives
By the end of this session, participants will be able to:
Structure Consultations: Framework for effective consultation.
Understand Different Consultation Models: Differentiate various models applicable in healthcare.
Compare & Contrast the Consultation Models: Identify key differences and similarities between consultation types.
Explain GPhC Standards for Providing Pharmacy Services at a Distance: Understanding the governmental guidelines on this topic.
Select Appropriate Consultation Method: Choose the best consultation method based on patient needs and circumstance.
Consultations
Patient Care: Central focus on the interaction between patients and healthcare professionals.
Preparation for Consultation:
Workspace/Consulting Area: Must be confidential, quiet, and properly positioned to ensure patient comfort and confidentiality.
Professional Work Attire: Importance of appearance in establishing professionalism.
Structure of Consultation:
Introduction: Initial greeting and setting the tone.
Body: Main content of the consultation.
Closing/End: Summary and final thoughts on the consultation.
Consultation: Introduction
Introduce Self: Make the patient feel acknowledged and comfortable.
Confirm Patient Identity: Verify the identity of the patient for safety and confidentiality.
Confirm Location: Especially important in remote settings, ensuring safety.
Safe Locations: Ensuring the patient is not in a compromising situation (e.g., driving).
Abroad (Guidance): Special considerations for patients located outside the country.
Golden Minute: Use the first minute effectively for establishing rapport.
Visual Cues: Be aware of non-verbal signals from the patient.
Consultation: Body
ICE:
Ideas: Understanding what the patient believes is the issue.
Concerns: The worries a patient may have regarding their health.
Expectations: What a patient hopes to achieve from the consultation.
Gather Information/History Taking:
Presenting Complaint: The primary reason for the consultation.
History of Presenting Complaint: Detailed background regarding the complaint.
Previous Medical History: Past relevant health issues affecting the current situation.
Drug History: Information about medications the patient is currently or previously taking.
Family History: Genetic predispositions to certain conditions.
Social History: Lifestyle factors impacting health (e.g., smoking, alcohol use).
Examination:
Clinical Images/Photo: Use of visual aids to address health issues.
Physical Examination: Hands-on assessment to gather more information.
Findings: Discuss the outcomes of history-taking and examination.
Options: Present various pathways or treatment options.
Counselling: Guide the patient through the next steps and available resources.
Consultation: Closing/End
Check Understanding: Ensure the patient comprehends the discussed information.
Opportunity to Ask Questions: Encourage patient engagement through questions.
Plan: Create a clear action plan for the patient’s next steps.
Safety Netting:
Discuss actions if symptoms worsen or change.
Identify red flags and who to contact in such scenarios.
Set expectations regarding improvement timeframes.
Signposting: Direct patients to additional resources.
Referrals: Initiate the referral process where necessary.
Consultation Models
Face to Face: Direct interaction with visible non-verbal communication.
Remote: Varieties include:
Telephone Consultation: Conducted via audio only.
Virtual Consultation: Internet-based consultation using appropriate software, often audio only.
Video Consultation: Both audio and video fed via a digital platform.
Written Consultations: Encounters via asynchronous communication methods.
Benefits: Range of Consultation Models
Patient Centred:
Increases accessibility and enhances patient choice which mitigates exclusion.
Hybrid Working:
Assists in staff recruitment and operational flexibility.
Virtual options allow for instant sharing of links and resources.
Benefits: Models Compared
Face to Face and Video Consultations:
Patient visibility is secured.
Face to Face:
Allows for personal interaction and assessing non-verbal cues (i.e., body language, posture, facial expressions).
Enables physical examination of patients, such as inhaler usage or blood pressure monitoring.
Easier to establish rapport and trust with patients.
Remote Consultations:
Positive implications for the NHS—greener insights into healthcare.
Increased accessibility benefits patient demographics:
Reduced commute times for patients.
Serving the working, housebound and rural populations.
Alleviates social interaction difficulties.
Ideal for sensitive discussions where patients may feel embarrassed.
Challenges: Models Compared
Virtual & Video Consultations:
Most time-consuming to set up; require proper technology and access.
Video Consultation & Face to Face:
Consultation room considerations and logistical challenges.
Telephone and Virtual Consultations:
Safeguarding issues arise due to the lack of visual cues and assessments.
Face to Face: Logistical Obstacles:
Anxiety from patients while discussing sensitive issues.
Risks of infection transmission during consultations.
Remote Consultations:
Potentially decrease rapport; reliance on verbal communication alone.
Opportunity for subtle cues can be overlooked.
Overburdening clinicians to make judgements without visual context.
Increase complexity in appointment bookings.
Necessitates staff training and consideration of regulatory/legal standards such as encryption.
Special attention required for digitally excluded groups lacking access.
Limitations on clinical assessments, for instance, blood pressure checks may be challenging.
Considerations When Selecting Consultation Method
Two-Way Communication: Ensured availability is a prerequisite.
Consent: Required informed agreement from the patient.
Mental Capacity: Ability of the patient to engage in the consultation.
Confidentiality: Ensuring patient information remains private and secure.
Gather All Required Information:
Determining necessary assessments and tests.
Conducting thorough examinations.
Provide Information:
Counselling and other resources must be delivered effectively.
Identify patients at potential risk (misuse of medications or risk of serious harm).
Consider Remote Consultations When
Straightforward Needs/Requests: Situations easily articulated by the patient.
Able to Provide Required Information: Patient is capable of supplying necessary details.
Access to Medical Records: Essential for informed decision-making.
Patient Capacity: Ensuring they can comprehend provided information.
No Need to Examine: Consultations not requiring physical assessment are preferable.
Monitoring Capability: Patients can self-report monitoring data like blood pressure readings or measurements.
Face to Face Consultations Preferable When
Complex Clinical Needs: High complexity necessitates personal interaction.
Inability to Ascertain Comprehensive Information: When patient data remains unclear.
No Access to Patient Medical Record (PMR): Important for informed assessments.
Uncertain Patient Capacity: Before relying on remote methods.
Need for Examination or High-Risk Conditions: Cases requiring direct physical assessment and diagnostics.
GPhC Standards: 5 Principles (1)
Principle 1: Governance arrangements safeguard health, safety, and wellbeing.
Risk Assessment: Regular evaluation of potential risks in practices.
Regular Audit: Ongoing assessment of procedures.
Accountability: Ensuring staff are aware of their responsibilities.
Record Keeping: Maintain comprehensive documentation of interactions and procedures.
Principle 2: Staff must be empowered and competent.
Trained and Competent Staff: Ensuring all employees are well-prepared.
GPhC Standards: 5 Principles (2)
Principle 3: Environment and conditions of premises must assure safety and wellbeing.
Premises Standards: Proper maintenance and adequate resources are crucial.
Digital Platform Requirements: Technology used must meet safety guidelines.
Principle 4: Delivery of pharmacy services must ensure safety and transparency.
Transparency and Choice: Patients have informed options available.
Managing Medicines Safely: Procedures must exist to protect patients.
Supplying Medicines: Mechanisms for safe distribution defined.
Information for Users: Clear communication of necessary information to pharmacy users.
GPhC Standards: 5 Principles (3)
Principle 5: Equipment and facilities used in pharmacy services must safeguard patients' health.
Specialist Equipment: Utilized efficiently for service delivery, must meet required safety protocols.
Case Study 1
Patient Profile: 65-year-old with hypertension and diabetes, living 20 miles from the pharmacy with limited mobility.
Access: Capable of audio and video calls.
Consultation Consideration:
Remote Consultation:
Suitable due to stable chronic conditions.
Technological capability supports a remote review.
Reduces travel burden significantly for the patient.
Case Study 2
Patient Profile: 30-year-old experiencing anxiety and depression with thoughts of self-harm.
Consultation Consideration:
Transition to a face-to-face consultation: If safe and feasible to ensure proper support.
Mental health concerns warrant closer observation and potential immediate intervention.
Face-to-face facilitates improved rapport and communication.
If in-person consultation is not feasible, escalate needs to emergency services or a crisis team for immediate support.
Case Study 3
Patient Profile: Reporting severe abdominal pain and dizziness. Request for a phone consultation.
Consultation Consideration:
Face-to-Face Consultation:
Necessary for severe conditions indicating potential serious medical issues.
Requires immediate attention, physical examination, and possibly urgent referrals.
Risks associated with remote consultations include potential delays in necessary interventions.
References & Further Reading
B1400: Remote and Video Consultations Guidance for Community Pharmacy Teams (PDF).
NHS England - Remote Consulting Guidelines.
Guidance for Registered Pharmacies Providing Distance Pharmacy Services via the Internet.