Clinician FAQs

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Clinician FAQs

These are the most common questions that you we have been asked by clinical colleagues. If you have other questions, please email us at hello@doctorinthehouse.net and we will incorporate them here.

How does this work?

Doctor in the House is a booking service providing:

  • General Healthcare Advice
  • Sign-posting
  • Red-flag identification

We link “at home” doctors (and other clinicians) with patients who cannot otherwise get advice.

We check the applications of all clinicians to ensure that they are appropriately registered with their professional body and that they are suitably insured.

We provide the scheduling platform, access to an online conferencing system (currently Zoom, but others are possible) as well as a note-taking platform, if required.

We then allow the clinician to make their availability known via a public booking website.

Patients can then book 20 minute slots for a free consultation with you. Both of you get an email with a conference-call link.

We have ensure there is a 10 minute break between patients for note-taking, follow-up and leg-stretching. This makes each “slot” 30 minutes in duration.

What is my time commitment?

You can make yourself available for as much or as little time as you wish from a single 30 minute slot to an entire day. The scheduling platform allows complete flexibility – so you can give your availability both regularly and in a date-specific manner.

Can I cancel or re-schedule an appointment?

Yes. Both you and the patient have full control over the appointment through the booking website.

What about no-shows / DNAs?

We will monitor patients that don’t show-up for the conference call. If this happens persistently, we can block someone with a particular email from making appointments.

Is there an employment contract?

No. We are providing you with a booking service. You are not contracted to us in any way. We have some terms-of-service that we would like you to agree to.

What happens if a patient complains about me?

It is important that you have your own professional indemnity that includes legal cover in order to protect yourself. To help protect you and patients, we will record all video consultations, so you and the patient will have access to that if you need it. We will also offer you a note-taking system. If you decide to use it, you will have a persistent record of your consultation. For complaints that you cannot deal with directly, we are happy to provide some mediation, but ultimately you will need to work directly with the patient in conjunction with your indemnity provider. More information about the patient complaint process in non-NHS care can be found here: https://iscas.cedr.com

Will patients have access to my email address or phone number?

No. We will provide you with a doctorinthehouse.net email address. Your phone number will not be used or made public. All communication will take place over video conference and email.

Can I withdraw my services?

Yes – you simply have to make yourself “unavailable” in the booking website. If you want us to remove you entirely from our listings, please ask and we’ll do that asap.

Am I going to get paid? Can I charge for my time?

No. Not at the moment. This is a COVID-19 crisis response and all practitioners are providing their time voluntarily.  In the future, we may offer paid consultations – but we have not addressed that at the moment.

Will I be publicly rated by patients?

Not at the moment. We will consider this in due course and offer this as a service to practitioners only if they want it.

Is this a commercial enterprise?​

At the moment this is not-for-profit. The service is being designed and funded by the team behind the Careful System (www.careful.online). Because no money is changing hands, the costs are currently minimised. After the COVID-19 crisis we will work with our clinicians and make Doctor in the House financially sustainable.

Am I insured by you?

We provide £1m of professional indemnity for those practitioners who are not otherwise insured. Our policy also covers legal expenses. If you have your own professional insurance through, for instance, a medical society, this will still be valid, providing that you inform them of this activity.

I’m not a doctor. Can I help?

Yes. We are grateful for volunteers from any healthcare profession that has suitable evidence of professional registration.

What are my other responsibilities?

We expect that you undertake follow-up with the patients that you see according to generally accepted rules of good clinical practice. The GMC has good advice on this here: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice

We take notes preferably on the Careful platform – we will supply a login. You may wish to and send a summary to your patient.  If you think it appropriate, and with the patient’s consent, you may wish to send a copy of your notes to the patient’s GP.

What happens if a consultation over-runs?

If for good clinical reasons you cannot see your next patient, we suggest that you cancel the following appointment and ask that patient to contact Doctor In The House directly. We will then try to give them an immediate appointment with another clinician.

What if a patient becomes abusive during a call?

You have control of the conference, so you can immediately terminate it. Politely inform the patient that their behaviour means that you cannot continue.

Assessments will be recorded so that you can use this recording if you need to follow-up or if the call results in a complaint.

What about seeing children?

We allow parents and guardians to make appointments on behalf of children, but we are aware that this will require precautions on your part to ensure that you are satisfied that the adult has the right to represent the child.

For children’s assessments, you should ensure that you have relevant information about both the patient and the adult.

If you are concerned about a potential safeguarding issue, you should inform Doctor in the House immediately on safeguarding@doctorinthehouse.net and we will help you assess what is the most appropriate action. If appropriate, you should also inform the adult of your concerns and that you will be making this representation.

What about safeguarding of vulnerable adults?

In the same way as with children, it is important that you identify and manage vulnerable adults (e.g. patients with dementia or disabilities) appropriately.

If you are concerned about a potential safeguarding issue, you should inform Doctor in the House immediately on safeguarding@doctorinthehouse.net and we will help you assess what is the most appropriate action. If appropriate, you should also inform the adult of your concerns and that you will be making this representation.

What is an Ada health assessment?

Telehealth consultations are a new form of medicine. Many practitioners are rightly a little nervous about their capability. We believe that having a powerful AI-driven diagnostic tool available will help to ensure that the right advice is given.

We therefore recommend to patients that they complete an Ada health assessment that they can discuss with you during the consultation.

Why Ada? We think it is the best of its type and that the motivations of its founders and management are aligned with ours. We should stress, however, that no business or commercial relationship exists between Ada and Doctor In The House. We are mutually respectful, separate organisations. They offer their service for free at the moment, as do we.

What if a patient is really unwell or needs urgent attention?

This is clearly something you need to be prepared to deal with. It is unlikely, but possible.

The patient might either need 999 — if their life or limb is in immediate danger — or they should be advised to go to hospital as soon as possible and report to the Emergency Department. Which of these is the most appropriate course of action is based on your professional judgement.

If you believe that the patient is vulnerable or not capable of calling themselves and you have the patient’s address, you can ring 999 on their behalf. If not, you must advise them to call. Because the telephone is separate from the internet, you can stay in the consultation while they do this.​

Can I rely on patients’ self-reported signs?

A patient can mis-report their own signs (e.g. a wrong temperature or heart rate). The limitations of tele-medicine means that you should investigate how self-reported signs were obtained. If this is important, you should ask the patient to repeat any measures while you are online.

Can I prescribe for patients?

Because Doctor in the House is not registered with the CQC, you may only prescribe only if you are personally registered with the CQC and it is within your scope of practice.

On balance, we advise that there are few prescription-only medications that are relevant to a tele-consultation with an unknown patient. You need to be reasonably certain of the patient’s identity. Since we do NOT do patient ID checking – so should do this while online. You will need to inform the patient’s GP.

If you are concerned about prescribing safely then don’t; advise the patient to seek a different level of care..

If you think the patient needs a prescription urgently, you should send the patient to a local GP or emergency department. You can help the patient by sending a summary of your clinical reasoning to their email address, and they can, if they wish, share that with their GP.

What advice is there on Coronavirus / COVID-19?

There is a lot of advice on Coronavirus / COVID-19, which changes frequently. This page is not the place to give this. We would advise that you start with your own professional body or with the government’s local page:

https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance

What safety-netting advice should I be giving?

Safety-netting is part of good medical practice. You must make it clear what the patient should do if their symptoms worsen. This should be given to them orally, during the consultation. If you think they may forget, you can write this in an email to them.

Safety nets can include: Ring 999, Visit your local ED, visit your local doctor, ring 111 for further advice. We do not recommend follow-up with Doctor in the House.​

What do I do about patients who want to see me multiple times?

At the moment, there is nothing to prevent a patient making multiple appointments with a single practitioner. However, you need to balance their needs with the needs of new patients. We do not recommend follow-up appointments with Doctor in the House since we do not offer treatment – only advice and sign-posting. If they need follow-up, patients should be encouraged to seek help elsewhere.

Why would GPs and others not just do virtual appointments from their surgeries?

Many GP practices are providing much, if not most, of their services via Telehealth appointments. We are hoping to reduce the burden on these GPs services by providing general healthcare advice, siignposting and red-flag identification.

If GPs have extra time why wouldn’t they do extra days, at their surgery?

They can. But that costs the NHS. Doctor in the House allows them to volunteer for the public good without reward, if they so choose.

GPs know their patients.  Does it matter that Doctor in the House doctors don’t?

We are not providing an alternative to a GP service. This is for general healthcare advice, sign-posting and red-flag identification. In this way, we are hoping to unburden some of the GP services (and Emergency Services).

GPs have access to notes.  Does it make Doctor in the House consultations less effective because notes are not available?

Potentially, but our scope is different (see above). And we are in the same position as many Emergency and Urgent Care settings.  The upside of Doctor in the House is that patents can be seen at an appointed time and get advice at home.

GPs can prescribe drugs.  Can Doctor in the House doctors?

Doctors who are CQC registered can prescribe drugs within the limits of their scope of practice (see above).

GPs can make referrals. Can Doctor in the House doctors?

We don’t recommend that Doctor in the House practitioners make referrals, — although they are of course entitled to do so, within their scope of practice. We would not recommend that referrals to secondary care be made by the patient’s registered GP. Doctor in the House practitioners can make notes and write to the GP with that recommendation.​

Should Doctor in the House be regulated by the CQC?

CQC registration is not required since we are not providing treatment. We are providing remote advice which is not “responsive” – i.e. is not triage. This is exempted from CQC regulation under the 2015 advice. See page 50 of this document.

Do Doctor in the House practitioners need to be independently registered with the CQC?

Doctor in the House practitioners can be registered indepeedtly with the CQC, but this is not necessary. Practitioners are not employed by Doctor in the House, and are therefore working as independent practitioners and not as employees.

General healthcare advice, sign-posting and red-flag identifation, which are the primary activities of Doctor in the House, are not considered treatment of disease according to the regulations.

If the practitioner wishes to provide treatment (e.g. a prescription), they must be independently registered by the CQC. However, we recommend against the provision of prescriptions except

Please see page 5 of the document for further explanation.

We have set up Doctor in the House to be safe, effective, caring, responsive, and well led. If you have any reason to believe that this is not the case, please email governance@doctorinthehouse.net.