In-person vs video consultation

Many consultations rely mainly on history: what happened, when, how it feels. Remote consultations can cover this well. Typical uses include reviewing test results, discussing treatment options, managing stable long-term conditions, mental health follow-ups, minor skin concerns that can be shown on camera, advice on sleep, diet or medicines, and administrative matters such as fit notes.

They can also allow a clinician to see the home setting, how a person moves, or breathing effort, and to involve relatives who live elsewhere. For some people, being at home reduces anxiety and supports openness.

A physical examination is irreplaceable for many problems. Feeling the abdomen, listening to the chest, checking joints, examining the throat and ears, measuring blood pressure properly, assessing a lump or testing nerve function cannot be done reliably on a screen. Children who are unwell, older adults with confusion, and anyone with red-flag symptoms need to be seen in person, and sometimes urgently.

Remote assessment can be slower to detect deterioration, and technical issues, hearing or language barriers and digital access can limit its quality. Safe services build in clear safety-netting: what symptoms to watch for and who to contact if things worsen.

The General Medical Council's guidance on remote consultations and prescribing expects doctors to judge whether a remote consultation is appropriate for the patient and problem, to obtain an adequate history, to verify identity, and to arrange in-person assessment where necessary. It also expects extra care when prescribing remotely and when a patient's records are not available.

NHS practices increasingly use triage to decide whether the right first contact is a remote or in-person appointment, and with which professional. Many people are seen by a pharmacist, nurse or physiotherapist rather than a GP, depending on the problem.

• Reviewing results, a medicine review or a routine follow-up: video or phone is usually sufficient.

• A lump, pain with tenderness, breathing difficulty, ear or throat problems, or a rash that is spreading: ask for an in-person appointment.

• An unwell child: seek in-person assessment promptly; use NHS 111 for advice if unsure.

• You find it hard to explain symptoms or have hearing or language needs: ask for a format that works for you, including interpreters.

• Chest pain, severe breathlessness, signs of stroke or heavy bleeding: call 999 rather than booking any consultation.

A video consultation is not a lower standard of care, but it is not appropriate for every problem. Nor is it only for minor issues, since many follow-ups of serious conditions are done remotely. And telephone consultations are not inherently less safe than video, provided the clinician has enough information.

Also, receiving a prescription remotely does not mean no assessment was needed; responsible services ask for relevant history and may decline to prescribe.