Table 3.
Guiding principles to inform application of the PERCS framework.
| SECTION A: PRINCIPLES UNDERPINNING OUR REMOTE SERVICE |
| 1. Infection Control (97% agreement) |
| We take all reasonable measures to ensure safety when there is an infection risk, including providing a range of ways for patients and staff to consult remotely. |
| 2. A Fair Appointment System (97% agreement) |
| We have systems in place to allocate appointments fairly, prioritizing the most urgent. We take account of the fact that some patients are unable to use some or all types of remote consultation. |
| 3. Informing Patients (97% agreement) |
| We provide information for patients on the different kinds of appointment available and the circumstances in which these may be appropriate. When offering appointments, we can explain why we think a particular type is suitable. |
| 4. High Clinical Standards (91% agreement) |
| We are committed to providing the highest quality of clinical care for all patients, whatever the type of consultation. |
| 5. Balancing Benefits and Risks (94% agreement) |
| We recognize that remote appointments have a different balance of benefits and risks—for example, greater convenience but less opportunity for physical examination, safe disclosure of sensitive information or raising potentially serious symptoms. |
| 6. Technical Security And Usability (89% agreement) |
| The technologies we use for remote consulting meet high standards of data privacy and security while also being easy to use. We may support occasional use of less secure technologies that are more familiar to patients where benefits of doing so outweigh risks and patients accept these risks. |
| 7. Patient Centredness (94% agreement) |
| Subject to capacity, we endeavor to offer all patients an appointment type which is timely, acceptable to them and addresses their needs. |
| 8. Staff Wellbeing (88% agreement) |
| We manage appointments so as to take account of staff workload and wellbeing. As far as possible without compromising patient care, we allow clinical staff to choose their preferred mode of consulting (e.g., taking account of their own clinical risk and stage of training). |
| 9. Environmental Responsibility (94% agreement) |
| Our policies on remote consultations reflect our commitment to reduce unnecessary travel and contribute to a greener, more sustainable future. |
| SECTION B: GUIDANCE FOR STAFF—BEFORE THE CONSULTATION |
| 10. Deciding on Appointment Type (92% agreement) |
| Where possible and appropriate, we offer patients their preferred type of appointment. When allocating appointment type, we take account of the reason for the request and have processes in place to identify contextual factors, including but not limited to |
| - Whether the patient is known to the practice team - Whether there is access to their full medical record - Communication needs e.g., visual or hearing impairment, literacy issues, difficulty understanding, need for interpreter - Privacy or safeguarding concerns - Infection risk |
| 11. Reducing Double-Handling (89% agreement) |
| We have measures in place, including effective triage, to ensure that patients are efficiently directed to an appropriate consultation type. Some phone or e-consultations will need to be followed up with a different type (e.g., face-to-face). |
| 12. Making Complex Judgements (93% agreement) |
| Since each appointment request is unique we encourage staff to use their judgement and discuss decisions with patients and with a senior colleague where appropriate. |
| 13. Mitigating Digital Exclusion (97% agreement) |
| When allocating appointment type, we try to take account of - The patient's access to private space for a remote consultation - The patient's digital set-up - Their capability and willingness to use different kinds of technology |
| If patients are unable to manage a particular type of remote appointment, we offer a suitable alternative. |
| 14. Supporting Continuity of Care (94% agreement) |
| Subject to resources, we aim to support |
| - Continuity of relationship (with own clinician) - Continuity of information (of the patient record) and - Continuity of multidisciplinary care (across a team) |
| 15. Embracing Uncertainty When Allocating Appointments (87% agreement) |
| We recognize the uncertainty associated with allocating remote appointments. For example, we are alert to - Patients who are concerned about seemingly minor or non-urgent complaints - Patients who are keen to have a face-to-face appointment but do not wish to give a reason - Patients whose condition has not improved following remote consultation(s) |
| 16. Addressing Complex Needs (93% agreement) |
| We try to ascertain and address the particular access needs of patients who may be vulnerable (due—for example— to multiple medical conditions, advanced frailty, learning difficulties or cognitive impairment) in a compassionate and flexible way. |
| 17. Safeguarding (100% agreement) |
| We are sensitive to the possibility that remote consultations may be compromised through interference or coercion. If there are such concerns, we offer a face-to-face appointment. |
| SECTION C: GUIDANCE FOR STAFF—DURING AND AFTER THE CONSULTATION |
| 18. Supporting High-Quality Interaction (94% agreement) |
| When consulting remotely, we allow time for both parties to optimize the connection, deal with technical glitches and check understanding. We recognize that it may be harder to convey empathy and build therapeutic rapport in remote consultations. |
| 19. Balancing Patient Autonomy with Support from Carers and Friends (100% agreement) |
| When consulting remotely, we deal directly with the patient if possible and respect their privacy. Subject to consent, and mindful of safeguarding issues, we welcome input from relatives or carers to help with the technology, communication or a remote physical examination. |
| 20. Embracing Uncertainty During the Remote Consultation (94% agreement) |
| We recognize the uncertainty associated with assessing and managing patients in remote consultations. For example, we are alert to - Poor audio or video quality - Absent or limited visual cues - Patient or practitioner stress - Limited scope for examining the patient - Possible presence of a third party off camera |
| 21. Remote Physical Examinations (100% agreement) |
| When considering whether to examine the patient remotely (e.g., by video or by asking them to take measurements), we take account of - The level of urgency - The patient's comfort and confidence - Their ability to assist (e.g., by placing a camera) - Whether relatives are—with the patient's consent—able and willing to help |
| We invite patients to attend in person if an adequate physical examination cannot be done remotely. |
| 22. Intimate Examinations and Images (94% agreement) |
| We do not undertake intimate examinations remotely. We follow legal and regulatory advice which limits exchange of certain kinds of intimate images. |
| 23. Information Continuity and Action Points (100% agreement) |
| During or after a remote consultation, we ensure that notes, images and other data are entered on the patient's record and appropriately coded, and that agreed next steps (e.g., investigations, referral, follow-up) are actioned. |
| SECTION D: LEARNING AND IMPROVEMENT |
| 24. Staff Training and Development (94% agreement) |
| We provide training, guidance and feedback to support staff on which type of appointment is appropriate in what circumstances, and for clinical trainees on remote consulting and triage. |
| 25. Patient Training in Digital Skills (80% agreement) |
| We provide support or signposting (e.g., to community provision) for patients who wish to increase their digital skills and confidence with a view to consulting remotely. |
| 26. Evaluation and Quality Improvement (87% agreement) |
| We measure our performance in remote consulting services, including capturing the patient experience, and set goals for improvement. |
Showing % agreement with each item in the final round.