Background

Teleneurology and telephone consultations have long been used in neurology.^{1 2} There is a lack of research data on using remote consultations for new neurology outpatients and only low-level evidence for their use in general practice. Remote consultations provide a mechanism for neurology care during the COVID-19 pandemic. Switching from face-to-face new appointments to remote (telephone or video) consultations allows continued provision of neurological services to patients while reducing hospital footfall; this could limit the spread of COVID-19 and avoid exposing vulnerable patients who attend the clinic to unnecessary risk.

We have built this document using advice from the UK General Medical Council (GMC) on remote consultations.³ However, the GMC’s advice is not wholly applicable in the setting of COVID-19; their safety concerns are mostly mitigated by the fact that we are the patient’s regular healthcare provider, with access to their notes and referral letters. The GMC also makes specific provision for departure from established procedures to care for patients in the highly challenging but time-bound circumstances of the peak of an epidemic.³

Given that the clinical history provides the greatest part of the information that leads to a diagnosis,⁴ remote consultation should be able to help many patients. In general practice, remote consultations were not associated with any statistically significant change in visits to the Emergency Department or any differences in rates of admissions or of patient satisfaction.⁵ However, remote consultations have been linked to more repeated visits: an average of two additional contacts for every 10 patients.⁶ Although a quarter of all patient consultations now occur on the telephone in general practice, there is no evidence base upon which to inform clinician training in this skill.⁷ This paper aims to help neurologists to conduct remote consultations, particularly in relation to the current …