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Video Consultation Best-practice and Recommended Setup

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We have collated below some guidance on using video consultations at your surgery. This is intended to provide what we have find is the best way run these consultations logistically whilst enabling you to deliver the best quality care in line with your clinical judgement and guidance.

Please note: We are not able to advise on any clinical elements of how to hold a video consultation. We advise that you enquire about any queries you have in relation to this with your CCG and/or LMC.

Your kit

Below is our recommended setup for any video consultation kit. This is aimed at providing the best possible video and audio quality.

Your setup should be in line with our technical specifications.

Webcam

The Remote Consultation solution supports any USB webcam that is compatible with your computer.

We recommend that your webcam supports the highest possible quality so that when internet speeds at both ends of the call are sufficient, your webcam is able to provide a clean, crisp image. A resolution of up to 720p or higher is advised.

Where it is possible, mount your webcam to the top of your screen. This angle will do a few things:

  • Make you feel a little less conscious about how you look – a camera mounted on a screen, or just a bit of a higher angle makes for a more natural interaction
  • Allows you to seem to be looking at the patient, whilst looking at them on screen, or when looking at your clinical system
  • Gives you back some desk space

If you are using a laptop, the inbuilt webcam will be sufficient for the purpose of video calls.

Audio – headset

We recommend that you use a headset when holding video consultations. This will provide you with the best audio for hearing a patient, and provide the best quality of microphone for patients to hear you.

The Remote Consultation solution supports any headsets that are compatible with your computer. You may find that USB headsets may be the best option as you simply plug into a single port and will likely be plug-and-play.

Make sure that you are comfortable with the audio settings on your computer so you can adjust your volume, mute your microphone, or select the right sound output (to stop sound coming out of your computer speakers or laptop).

Broadband connection

We recommend that your practice’s IT team review our technical specifications for Remote Consultation to ensure that your practice’s broadband connection is stable and fast enough to handle video consultation traffic.

If you see any issues with your connection speed, please raise this with your CCG who may be able to assist with resolving this.

It may be necessary to ensure that any non-essential devices are not connected to the practice wifi network to protect internet speeds and network traffic, especially if you experience any connection quality issues or dropped calls.

We would recommend performing a stress-test where every clinician who is likely to be making calls at the same time, holds test video calls at the same time. You should also throw in some scanned documents being actioned and medical records being accessed across the surgery to see if you experience any performance issues across your clinical systems and video calls.

We have built video consultations on the industry-leading Nexmo platform which is used by many of the leading video consultation suppliers, because of its stability and dynamic call quality adjustments. In short, should your’s or the patient’s internet speed slow, the video quality will begin to decrease, whilst protecting audio quality, so that the call can continue giving a chance for the speed to improve.

If clinicians are working from home, then the same considerations need to be given around broadband speed to ensure that they have sufficient speed to enable remote working. Again, consideration should be made to what other family members are doing on the internet during video consultation times. If clinicians only have access to a 10-20Mbit line, it is advisable that no one is watching streaming services, or playing online games that can drain internet speeds. It may also be advisable to plug in a laptop straight into a broadband hub to avoid any WiFi signal problems, and this connection is usually much faster than WiFi connections.

Where you are holding video consultations

To avoid any suggestion that a consultation is not confidential, you need to think carefully about where you are holding video consultations.

Consultation room

If a clinician is working in a surgery, video consultations are best held in a consulting room. This ensures the best privacy for the patient, and provide confidence when it is seen that the call is happening in a private space.

When holding telephone consultations, it is possible that these could be held in an office environment where conversations cannot be over-heard, and where patients can be confident that they are not being over-heard. However, this is a good way of optimising consulting room space.

Working from home

It is recommended that video consultations and telephone consultations are held in a private room, such as a home office or spare room.

It will be important that you are not interrupted during consultations to ensure that patients feel that consultations are confidential.

Starting and ending the video call

Make sure to only start the video call once you have your headset on and are fully ready to hold the call. This will provide the most professional quality to the start of the call, so the patient does not hear/see you fumbling with equipment.

Greet the patient as you would any normal consultation or telephone consultation and follow your usual clinical approach to discuss the health issue the patient has. It may also be advisable to ask the patient if it still convenient to hold the video consultation now.

When you are ready to end the call, simply say good bye to a patient as you normally would and click the red End Call button.

Use your call controls during the video call

When you are in a call, there are options available to you to control the call, should you need to.

The Mute option is very useful should you need to quickly sneeze or cough. Where possible, you should advise a patient that you are going to put them on mute while you refer to something. This ensures that the patients is informed as to what is happening on the call.

The Stop Video button is useful for pausing the video in case you need a moment of privacy, or you don’t want a patient to see something – this could be someone needing to come into the consulting room, or when referring to something from a shelf. Again, you should advise the patient that you are going to do this, so that the patient does not think that there is an issue with the video feed.

Asking to see any symptoms

When asking for patients to show you any symptoms they have, be aware of the video quality. Visual clues like how people move, shapes, etc will likely be very useful.

However, it may be that viewing rashes, wounds, and other issues that rely on a crisp, high resolution image may not be as suitable to be viewed using a video feed, due to the nature of the constantly moving image and current video technologies.

If you need a clearer image, we would suggest having an NHS mail account that patients can send photos to so you can make a clinical judgement.

In the future, we are looking into solutions to permit patients to send in images when requested directly into myGP Connect

Use all electronic means available to you

There are a great number of technology solutions available to support patients remotely. This makes it far easier for patients, limits potential contact with other individuals, and can help patients who have had to self-isolate:

  • Pharmacy Nomination – ensure that the patient has a nomination, or that the current nomination is still correct
  • Use EPS – make sure where possible that prescriptions are being sent electronically
  • Send any links for information using an text message solution, such as iPLATO (myGP users receive text messages, for free, when using the app)

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