Table 3 Examples of qualitative data

Legal Issues

relating to indemnification between the patient and the clinician potentially resulting from their VC interaction

• Things relating to professional indemnity are vague … I am not aware of standards of clinical practice for virtual consultation which are the necessary starting point for defining the limits of indemnity insurance.

• Remote consultation has been introduced without any universal standards so we are depending on the former system of protection to function within a very different context, and without any testing of the system to highlight weaknesses. I feel concerned that legally the person reporting an issue might be opening themselves up to litigation because the existing safeguarding legal framework might not apply to new ways of working.

• I would value a legal opinion.

• If working at home need to check with house insurance and council tax is covered

• We have had discussions around what the outcome might be if a patient was recording the consultation without our knowledge and then attempted to use the recording as evidence for a complaint/legal case.

• Would anticipate organisational cover as they have insisted we work in this way.

• At the moment it is ok as its emergency pandemic setting, but that will all change when its being reviewed like all investigation’s years away from now and any guidance you can produce will help inform the future developments in this field.

• Additionally, there is the massive area of effectiveness, a patient might try to pursue a negligence claim on the basis that the clinician was ineffective and missed something through using remote consultation. The whole area of remote diagnosis is litigation just waiting to happen

Safeguarding Issues

the process of protecting individuals for whom we care

• I had a child who had injured themselves and I was concerned it was self-harm. I felt the consultation was difficult because the mother was with her in the room. She was 14. i was afraid to ask the mother to leave the room because I do not think I am allowed to be on the call with a child, it’s a very difficult situation. I had to involve the GP which I felt uncomfortable about.

• Unsure if strictly legal but a young female patient was inappropriately dressed, nothing untoward was visible but I felt quite uncomfortable with the situation, had it happened in a F2F consultation I would have asked her to put clothes back on but the consultation appeared to have been in her bedroom and I wasn’t aware of her clothing until it was a bit too late.

• I do not always see the child the consultation is about. So, I neither see nor talk to the patient.

• We became aware post consultation that the patient’s brother was acting as the patient.

• Feel concern that the NHS system surrounding safeguarding will not adequately support the new ways of working. I have not had any direct guidance about how things might need to adapt or if a possible safeguarding issue discovered through remote consultation requires different processes or different standards of evidence collection. Currently it feels as if the frontline clinician might be blamed for any failings in the system when in reality, frontline staff are working without a clear framework.

• Follow usual policy, flag up with the safeguarding team.

• Bring the patient in for an urgent face to face appointment.

• If required contact the patients GP. If serious concerns, contact the emergency services as appropriate.

Safety Issues

risks to the patient and clinician resulting from the VC interaction

• Assess the situation, if considered an emergency would call 999. If considered non urgent would give patient the appropriate advice eg to contact their GP or provide safety netting advice. Would check back on patient again later that day or ask patient to contact me. Would also document incident, complete clinical incident procedure, ring GP or write letter to GP (depending on nature of incident). This is currently not included in our SOP.

• I am concerned that I am unable to fully risk assess the patient’s ability and environment so stick with safe practices which may not be the progression that is required.

• If the patient were unresponsive on the other side of the camera, I would call 999. If the patient was responsive, I would discuss with them the best way forward (them phoning for assistance, me arranging assistance).

• Patient is in their own home environment, so they are totally responsible. In fact, it should be considered as lucky episode as I will call 999 if I am worried about patient’s wellbeing with name and address etc. We cannot stop usefulness of virtual consultations. We must embrace it.

Security Issues

risks resulting from data loss or data breaches because of the VC interaction

• Consider security of virtual platforms.

• If I am being recorded [what if] that is then edited and or shared.

• Data protection relating to setting used for consultation and privacy.

• Data protection, consent, confidentiality, and risk.

• Confidentiality, I do not know who else is either in ear shot or just off screen.

• Patients taking calls in places that were not confidential or with unnamed people chipping in with inappropriate answers.

• Data breach

• Thank you for reviewing this area. I think we are all deeply involved in an area we just do not understand. At the moment it is ok as its emergency pandemic setting, but that will all change when its being reviewed like all investigation’s years away from now and any guidance you can produce will help inform the future developments in this field.

Other issues

Issues identified that do not fit the above categories, or they fit within multiple categories

• Starting appointment on time has been an issue. The patient is sometimes busy with other work.

• Deciding which platform to use is not straightforward and the Trust decision makers I have no doubt will not necessarily have the patients best interest at heart.

• Students using virtual platform, adequate supervision for them.

• Connection dropping, poor picture. Difficult to get a good angle to see patient properly. Patients can struggle to understand instructions without hand’s on feedback.

• I think your examples are quite concerning as I have not really considered any of these issues. Advice and examples of all these issues are very much needed. Thank you for reviewing this area. I think we are all deeply involved in an area we just don’t understand. At the moment it is ok as its emergency pandemic setting, but that will all change when its being reviewed like all investigation’s years away from now and any guidance you can produce will help inform the future developments in this field. Thank you.

• Remote form filling for investigations can be a challenge.