GP Video Consultations
1. Guidelines for interprofessional collaboration between GPs and other medical specialists providing video consultations (RACGP)
The Royal Australian College of General Practitioner (RACGP) has published Guidelines for interprofessional collaboration between general practitioners and other medical specialists providing video consultations. The guidelines aim to facilitate effective collaboration between GPs and other medical specialists at a distant location by video consultation. The guidelines primarily focus on real-time video consultations where a patient and their usual GP are at the patient-end of the consultation and another medical specialist is at a distant location. The guidelines may also be useful for scenarios such as store and forward video consolations.
2. Implementation guidelines for video consultations in general practice
The guidelines are intended to assist the general practice team to establish video consulting within their practice. It includes guidance on a range of implementation, technical and usage issues.
Read the guidelines in conjunction with the ‘Standards for general practices offering video consultations: an addendum to the Standards for general practices’ (4th ed). The standards aim to help GPs to interpret safety and quality issues for video consultations.
This section refers to the situation where a patient with the support of their GP has video consultation with another specialist.
1. Allow time to develop new processes
Video consultations present a shift in the way health care professionals provide care for their patients. They involve new technology and alterations to workflow, and there may be some natural resistance to change.
Implementing a video consultation service should be gradual, requiring engagement, education, and understanding, and acceptance from clinicians, staff and patients.
2. Allocate staff to manage and coordinate video consultations
Engaging an enthusiastic video consultation coordinator can help to integrate video consultations into the primary care setting. This might be the practice manager, administrator or practice nurse. The following actions might help to ensure minimum disruption of workflow and maximum confidence in the effectiveness of videoconferencing:
- coordinating bookings and clinician availability;
- ensuring equipment is functioning properly;
- advance testing the interoperability of patient-end/distant specialist videoconference equipment;
- providing a patient information brochure to prepare patients for video consultations;
- preparing contingency plans and troubleshooting guides.
3. Staff training
Staff acceptance, confidence in the benefits of telehealth, and competence using the technology are key to the success and sustainability of telehealth in a practice. Explain to staff why video consultations are being introduced and their value in communication and patient health care.
Staff training specific to the needs of the practice is necessary before implementing video consultations to:
- demonstrate the effectiveness of videoconferencing methods;
- reduce the resistance to change, especially when facing early technical challenges;
- ease the transition from traditional to virtual services, eg adjusting to administrative procedures, scheduling and other workflow changes;
- ensure that new roles or responsibilities are defined;
- ensure that context-specific needs are addressed early.
Practices should have relevant policies and procedures, particularly a documented plan, for managing technical contingencies during a video consultation. They could potentially compromise the effectiveness of the consultation or a patient’s safety. For example, easy-to-read troubleshooting guides for common technical difficulties, completing an interrupted consultation by telephone, and ready access to technical support to fix fundamental problems.
What to change: workflow and process (RACGP)
1. Information for patients
It is essential that patients are aware they will be attending a video consultation. Patients should be made aware of this new form of communication, understand the fees that apply, be provided with etiquette tips, and understand the need to arrive 15 minutes early.
A patient information brochure template is available at www.racgp.org.au/ telehealth/templates for practices to adapt and use to provide information to their patients about their video consultation service.
3. Booking procedures
Three parties need to be coordinated for a single consultation (the patient, the specialist, and the GP). Therefore, the booking should ideally be completed by one person who has access to all three at the same time.
4. Procedures for the video consultation
Prior to the first consultation, a test call should be made on each new computer in each new setting. There also needs to be an agreement on how to charge for the service.
Figure 1 demonstrates a flowchart suggesting the workflow for a dual care video consultation.