Inclusive online video consultations: what you need to know
Knowledge into Action Briefing
About this briefing
This briefing is to share key insights from Thrive by Design’s national and local work on online video consultations.
Work by Thrive by Design which underpins this briefing:
Discovery co-design project on online video consultations in direct clinical practice for Leeds and York Partnership NHS Foundation Trust.
A review for Leeds and York Partnership NHS Foundation Trust of their video consultations Standard Operating Procedure using co-design principles, considering digital inclusion and potentially innovative solution.
Co-design work for the Nuffield Department of Primary Care Health Sciences, University of Oxford on what inclusive remote video consultation looks like. See further developments of this work: Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics, Trish Greenhalgh et al (2021)
See our full Knowledge into Action Briefing for full details, summary below.
Key points
There is widespread support for remote consultations from users and staff when delivered appropriately with choice and the right support in place. It should not be presumed that online video consultations will be acceptable as a long-term option rather than an effective substitute when face to face options were not possible in the pandemic. While there is a willingness, appropriate support is needed to gain confidence, ensure effective use of and fully embed online video consultations longer term.
Willingness to try online video consultations varies. For example, it is lower for people over the age of 70. Children and young people may feel less able to communicate effectively with clinicians and more likely to defer to parents and carers, or feel unable to disclose particular concerns if parents or carers are listening.
The use of online video consultations, if not supported in the right way, is at risk of widening the digital divide. Even where digital platforms are available, there will be people who are excluded, for example, those with low digital literacy, poor connection or unable to afford the cost of data for video calls.
Ensuring equitable access to services for people must be assured. A person-centred approach, supported through a multi–channel suite of remote, telephone and face to face options is needed.
Clinicians should avoid making generalised assumptions about who can benefit from online video consultations. There should be a nuanced approach to assessing when and under what circumstances online video consultation is suitable. Exclusion factors are complex and can change over time.
There is a need to identify potential barriers due to digital exclusion and how to tackle them, including who may benefit from training on how to use technology (considering both people who use and deliver services).
Staff should be enabled to signpost people to digital support. For example, voluntary, community and social enterprise sector organisations which can provide information and resources to support people affected by digital exclusion.
There is a need for not only technical training for staff, but also virtual communication training.
Trusts and Integrated Care Systems should refine Standard Operating Procedures for online video consultations to achieve a consistent and best practice use of online video consultation and draw on national good practice resources and local support e.g. from the voluntary, community and social enterprise sector.
Implications for practice
Focus on co-design and improving the service rather than implementing a technology
Ensure equitable access
Support and training for staff
Consistent and best practice use of online video consultation at an organisation level
See the full briefing for further detail.
Areas that Standard Operating Procedure for online video consultations need to cover:
A triage process at an organisational level that allows for service specifics and clinical reasoning to ensure the personalisation of online video consultation.
Robust guidance for new (and existing) online video consultation users.
How platforms interfaces with other aspects of the system (e.g. internet browsers and firewalls) and ensure good and dependable internet connection).
Guidance or checklist on how to test and use equipment
Clear session expectations.
Signposting across different clinical areas or some illustrative case study examples to guide clinicians.
The need for private space to carry out remote consultations and advice to staff working from home/blended approach.
The latest good practice on safeguarding.
Information on how to tackle barriers across particular groups.
Signposting to further information and guidance across different clinical areas.
We have developed a checklist to use and consider when implementing and improving your remote video consultation offer.
Shining a light on good practice
Accessible information to support clinical and situational judgement
The IRIHS research group at the University of Oxford (2020) supported by the NIHR have developed a comprehensive checklist for clinicians.
NHS England and NHS Improvement (2020) also provides a patient guide.
The Royal College of Nursing (RCN) (2020) provides some ‘top tips guidance’ on initiating and concluding a remote consultation, they also cover principles of mental capacity legislation and a script for questions and responses.
The Royal College of Psychiatrists (2020) provides guidance on key considerations, based on the ‘6 Cs’ for staff who run online virtual consultation.
The General Medical Council produced a flow chart to help doctors apply their ethical guidance to manage patient safety risks and decide when it’s usually safe to treat patients remotely.
Wider guidance
NHS England and NHS Improvement (2020) provides advice at the organisational level on planning, setting up technology and communication, setting up workflows, training and piloting, going live and offers a checklist of things for individual clinicians to go through prior, closing and after the video consultation. Check here for the latest guidance.
Conclusion
Implementation of online video consultation needs to follow a socio-technical systems approach, continually adjusting the technical elements – technology, infrastructure, and processes and socio elements – people, culture, and goals to become better aligned.
Co-design with service users and carers should be at the heart of the approach to avoid exclusive digital transformation.
The unprecedented use of online video consultation provides an opportunity to evaluate the strengths and limitations of online video consultations.
See the full Knowledge into Action briefing for more detail.
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