Remote Consultations (Telemedicine) and the GMC
Remote Consultations – GMC Policy and Law
The GMC sets out guidance on how a doctor should conduct themselves when holding remote consultations. UK doctors who hold remote consultations (by videoconference or by phone – also known as Telemedicine or Telehealth) with patients in the UK will need to hold registration and a licence to practice. GMC standards will apply to all clinical work that a doctor undertakes in the UK.
CQC Registration and Similar
A doctor who provides certain types of clinical advice or treatment in England will also have to work through a Care Quality Commission (CQC) registered organisation. Those working in Scotland, Wales and Northern Ireland will also likely need to work through registered organisations, that are registered with Health Improvement Scotland (HIS); Healthcare Inspectorate for Wales (HIW); Regulation and Quality Improvement Authority in Northern Ireland (RQIA) – respectively.
The CQC’s regulations are not always easy to follow.
Decision Tree – How to decide Whether a Remote Consultation is Appropriate
The GMC has developed a simple decision tree to identify when it is appropriate (or not) to hold a remote consultation, so that doctors can best meet the needs of their patients rather than the needs of the doctor. The GMC underscores the importance of applying three principles to the decision being made. A doctor should also ensure that they are familiar with the medicines that can be prescribed remotely, and those that can only be prescribed following a face-to-face consultation. See, by way of example, the GMC guidance called Good Practice in Prescribing Medicines and Medical Devices.
Remote Prescribing – GMC “High Level Principles”
The GMC has set out the principles that must be applied when prescribing, which it describes as High Level. The GMC states that the high level principles are “… is not clinical guidance or new guidance from regulatory bodies” but they are principles that have been agreed between “a range of healthcare regulators and organisations”. The High Level Principles in Remote Prescribing webpage includes references to UK standards and overseas standards.
The GMC’s FAQs on Remote Consultations are especially headful guidance and discuss confidentiality, examinations, and intimate examinations.
Prescribing for Patients Overseas
The High Level Principles information states as follows, in relation to overseas patients:
“If UK based healthcare professionals are considering working for service providers based in other countries, it’s important to be aware that there may not be established local mechanisms to provide effective systems regulation and this may impact on patient safety. Before providing remote services to patients overseas the healthcare professional should check if they are required to register with regulatory bodies in the country where they are based, and where the patient is based and where any medicines they prescribe are to be dispensed. They also need to check they have an arrangement in place to provide indemnity or insurance to cover their practice in all relevant countries.
When prescribing to a patient overseas, UK based healthcare professionals are expected to consider how they or local healthcare professionals will monitor the patient’s condition. The healthcare professional needs to take account of any legal restrictions on prescribing or the supply of particular medicines, and any differences in a product’s licensing or accepted clinical use in the destination country. They should follow UK and overseas legal requirements and relevant guidance on import and export for safe delivery, including from the Medicines and Healthcare products Regulatory Agency.”
This is something that the GMC will look at when considering whether a doctor has conducted themselves appropriately. Note, also, that any work carried out overseas must usually meet the clinical standards of the UK, where a doctor os registered with the GMC. See for example the case of: Sastry v General Medical Council  EWHC 390 (Admin), where Mrs Justice May held (with bold added by us for emphasis):
25. [In relation to Stage 1 of MPT Proceedings]: “That is not to say that in applying UK professional standards a tribunal simply translates the behaviour directly to a UK setting, that would obviously be wrong. In considering whether or not a registrant undertaking professional duties outside the UK has fallen short of levels of professional conduct which the UK public is entitled to expect from its doctors, a Tribunal must take account of any particular limitations or local practices which apply in the foreign location. In short, a registrant’s behaviour is to be judged by reference to UK standards but taking into account local conditions and practices. That is the approach that the legal assessor advised the MPT to take here.”
26. “Specifically, at Stage 2, when considering impairment, I consider that the MPT was right to use GMP as a reference by which to judge Dr Sastry’s behaviour, albeit being careful to take into account local conditions. The obligation to comply with GMP comes with registration. As appears from the GMC Guidance given to doctors (Guidance for doctors: requirements for revalidating and maintaining your licence, at para 1.2), there are two types of registration: with a licence to practise and without. A doctor may not practise in the UK without a licence but doctors practising wholly outside the UK do not need to hold a licence, indeed they need not be registered with the GMC at all. However, the Guidance is clear: if doctors choose to be registered with the GMC they must follow GMP. Doctors seeking to obtain or retain GMC registration, with or without licence, are obliged to practise in accordance with GMP.”
(date of judgment 25 February 2019)
The GMC conducted some research in 2018, which noted the approaches of regulators in other countries. See the publication Regulatory Approaches to Telemedicine (19 June 2023). While it is a useful read, it is not particularly illuminating about the approach that the GMC prefers UK registered doctors to adopt.
It should be observed that there are many reserved activities which only registered professionals can provide in the UK healthcare. The GMC requires doctors who provide medical services to patients based in the UK to be registered with the GMC, even if the doctors are doing so from overseas.
What about the position of overseas registered doctors who are based in the UK?
An overseas-registered doctor cannot provide any services of a doctor to UK-based patients. Further, a doctor who is based in the UK but who not registered in the UK, and who provides telemedicine or remote consultations to overseas patients (only), may be at risk of prosecution if they hold themselves out (or practise) in a way that the GMC considers is breaking the law. The dividing line is not clearly set out on the GMC website, as far as we can see.
On one reading of GMC’s approach to regulations, no person should be providing telemedicine services of a doctor, from the UK to patients overseas, even if they are registered in the country where they are delivering the medical services. As the evidence compiled has only been publicised in June 2023, we expect to see the GMC develop policy in the near future. Advice should be sought from the GMC where an overseas doctor wishes to practice on UK soil, to determine the current position.
CQC (Prescribed Activities)
CQC state that “an activity is only a regulated activity if it is carried on in England” – Regulation 3 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. The CQC might therefore determine that a doctor who is carrying out medical services on UK soil, albeit to an overseas audience, is in breach of the regulations and committing a criminal offence. The position is not entirely clear. Advice should therefore be sought from the CQC, where a doctor intends to provide telemedicine type services from an address in England.
Paragraph 9(2) of Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 holds that CQC regulation applies to “Medical advice in cases where immediate action or attention is needed, or triage provided, over the telephone or by electronic mail by a body established for that purpose”. In March 2017, the CQC published a checklist of activities it would scrutinise when inspecting organisations that provide remote consultations: Clarification of regulatory methodology: PMS digital healthcare providers.
Legal Advice on Remote Consultations Law
For legal advice or assistance on the law, regulations and policy relating to remote prescribing and remote consultations, call Doctors Defence Service (DDS) on 0800 10 88 739 or use our Contact Form.