Five years ago, almost every prescription written in general practice followed a face-to-face consultation. Today around a third of GP appointments take place by telephone, video or online consultation, and remote prescribing in primary care has become routine work rather than an emergency adaptation introduced during the pandemic.
Practice teams have reorganised their daily routines, and the regulatory framework has evolved alongside them. For practices and PCNs working out how remote and face-to-face consultations should run together, the question is no longer whether to offer remote slots but how to deliver them while meeting clinical and governance expectations.
Key takeaways
- Around a third of GP appointments are now conducted by telephone, with video and online consultations accounting for a smaller but rising proportion.
- The GMC’s updated guidance on remote consultations and prescribing sets specific obligations for clinicians who cannot examine the patient in person.
- Total triage models route patient requests through a triage step before any consultation slot is offered.
- Clinical pharmacists can deliver structured medication reviews, repeat authorisation and overdue-monitoring searches effectively by phone or video.
- Practices need clear protocols defining when a remote consultation is clinically appropriate and when it is not.
What Remote Prescribing Covers in Primary Care
Remote prescribing refers to any prescribing decision made without the clinician and patient being in the same room. In primary care that includes telephone consultations, video appointments and prescriptions issued in response to an online consultation submitted through a system such as accuRx, Klinik or eConsult. The same definition applies when a clinical pharmacist conducts a structured medication review by phone or video and issues or amends a prescription as part of that review.
The Electronic Prescription Service handles the dispensing element of the process. EPS has been the default since 2019, and around 95% of items issued in primary care now reach the patient’s nominated community pharmacy electronically, so patients no longer need to collect paper scripts from reception. That change has removed one of the older bottlenecks in repeat prescribing and made remote consultations operationally complete from request through to dispense.
How Widely Remote Consultations Are Used in General Practice
Monthly NHS appointment data shows the pattern clearly. Around a third of GP appointments are now delivered by telephone, with video and online consultations accounting for a smaller but rising proportion of the total. Face-to-face still leads in absolute terms, but the share has settled well below pre-pandemic levels and has remained at that lower level since.
A remote clinic moves through patient contacts more quickly than a face-to-face one, which compresses each prescribing decision, shortens the time available to document the contact and raises the error risk when calls accumulate. In response, many practices have reorganised their session patterns and now ring-fence administrative time that the older face-to-face model did not require.
GMC Principles for Remote Prescribing
The General Medical Council updated its guidance on remote consultations and prescribing in 2021. The principles are not new in substance, but they set out clearly what clinicians must do when they cannot examine the patient in person. Before issuing a remote prescription, the prescriber must:
- Have gathered enough information to make a safe clinical decision.
- Consider whether the presenting problem can be assessed without a physical examination.
- Document the contact in a way that supports continuity of care.
Particular caution applies to controlled drugs, medicines with abuse potential and treatments where a physical examination materially influences the decision. The principles apply equally whether the prescriber is a GP, a clinical pharmacist with independent prescribing rights or any other registered prescriber working within their scope of practice.
The Care Quality Commission has raised separate concerns about online prescribing services operating outside NHS general practice, particularly where weight-loss medicines and opioids have been prescribed without adequate clinical assessment. The regulator now inspects against these standards across both NHS and independent providers, and any findings carry through to a practice’s overall rating.
How GP Practices Are Adapting Workflows
Most practices now operate total triage, which means that any patient request, whether made by phone, online form or in person at the desk, passes through a triage step before a consultation slot is offered. The triage decision determines whether the patient is seen face-to-face, called back by phone, given a video appointment or directed to another team member entirely.
This arrangement redistributes prescribing work across the team, since a request that once produced a GP appointment may now be answered by a practice pharmacist over the phone, a paramedic on a home visit or a nurse-led clinic. Where a prescribing decision is involved, the clinician taking the call needs the authority and competence to act on it, which is one reason independent-prescribing qualifications have become a recruitment priority for PCN clinical pharmacists.
The Role of Clinical Pharmacists in Remote Care
Tasks that translate well to remote delivery
Several pharmacy tasks translate cleanly to remote delivery. Structured medication reviews work well by phone or video for patients without significant sensory or cognitive impairment, and repeat prescribing authorisation involves documentary work that does not require in-person contact. A pharmacist working remotely across several practices can move through a list of patients with overdue blood monitoring more efficiently than one tied to a single building, and that efficiency translates into shorter waits for the clinically most pressing review work.
Where face-to-face contact remains necessary
There are clear limits to what remote pharmacy work can cover, however. Care home reviews, complex polypharmacy decisions in frail patients and any case where the clinical picture is unclear continue to require face-to-face contact, and a well-designed remote pharmacy service builds those limits into the model from the start rather than discovering them under pressure.
Common Pressure Points in Remote Workflows
Documentation tends to be the first thing to suffer when remote consultations run long, which is why well-run services use a short, structured template that records the core clinical information for each contact. Doing so protects both patient and prescriber if the consultation is later reviewed clinically or as part of a complaint. Escalation routes deserve equal attention, because a remote clinician who reaches the limit of what can safely be decided at distance needs a defined pathway into a face-to-face assessment, not an improvised one.
For PCNs building remote prescribing capacity, working with an experienced provider can help fold these arrangements into a clinical governance framework from the outset, rather than leaving individual prescribers to work out the rules in isolation.