Can you prescribe without seeing the patient in the UK?
Yes, if it is safe to do so. Remote prescribing is a normal part of general practice, community pharmacy, out-of-hours care, NHS 111, outpatient follow-up and online services. Repeat prescribing of a stable long-term medicine, or treating a clearly described minor illness, can often be done safely by telephone or video. What changes remotely is the information available to you. You cannot examine, you may not see the patient, and you may not be certain who you are speaking to.
Some patients find remote care harder, including people with hearing or cognitive impairment, people with limited English, and people without private space or reliable technology. Accessibility and safeguarding are part of deciding whether remote care is right for a particular person.
What are the high level principles for remote consultations and prescribing?
A group of UK regulators and professional bodies, including the GMC, NMC, GPhC, General Dental Council, General Optical Council, CQC, Healthcare Improvement Scotland, Healthcare Inspectorate Wales, the Royal Pharmaceutical Society and the Academy of Medical Royal Colleges, agreed a set of high level principles for anyone who consults or prescribes remotely. The HCPC also signposts its prescribing registrants to them. In summary, they ask you to:
- Make patient safety your first priority, and raise concerns if a service lacks safeguards such as identity checks.
- Recognise vulnerable patients and take steps to protect them.
- Introduce yourself, your role (and registration if online), and explain how the consultation will work.
- Prescribe only when it is safe; if it is not, signpost the patient to another appropriate service.
- Obtain informed consent and follow mental capacity law.
- Carry out an adequate assessment, accessing records or verifying information by examination or tests where necessary.
- Explain the options, including not treating, in terms the patient understands.
- Arrange aftercare and, unless the patient objects, share information with others involved in their care.
- Keep notes that fully explain and justify your decisions.
- Keep up to date with training and guidance for remote care.
Doctors should also follow the GMC's guidance on prescribing and managing medicines and devices, nurses and midwives the NMC Code, pharmacy professionals the GPhC standards and its guidance for pharmacies providing services at a distance, and all prescribers the Royal Pharmaceutical Society Competency Framework for all Prescribers.
How do you run a safe remote consultation?
A remote consultation follows the same logic as a face-to-face one, with extra steps to make up for what you cannot see. This structure works for telephone, video and online contacts.
- Prepare: Review the record, recent results, medicines, allergies and any recent contacts before you call. Make sure you are somewhere private.
- Introduce yourself and confirm identity: Give your name and role. Confirm the patient's identity with at least two identifiers. If a relative or carer is speaking, confirm who they are and that the patient agrees.
- Check location, privacy and consent: Ask where the patient is, in case you need to send help, and whether they can talk freely. Explain that you may need to see them in person.
- Take a focused history: Start open, then ask specifically about red flags. Ask the patient to describe what you would normally observe, such as colour, swelling, breathlessness or a rash.
- Gather objective information: Observe on video where possible. Use home readings if the patient has a thermometer, blood pressure monitor or pulse oximeter. Use images only within your organisation's policy, and never for intimate areas unless policy specifically allows it with safeguards.
- Decide: remote or in person: Ask yourself honestly whether you have enough information for a safe decision. If not, arrange an in-person assessment with the right urgency.
- Plan, safety-net and check understanding: Explain the likely diagnosis and uncertainty, name the symptoms that should prompt help, how quickly and where, and use teach-back.
- Document: Record the mode of consultation, identity and consent, history, any observations, your reasoning, the plan and the exact safety-netting advice.
When should a patient be seen face to face?
Deciding when remote care is not enough is the most important judgement in remote practice. Many incidents involve a patient who needed examining but was managed by telephone, often over several contacts.
| Situation | Why remote care may not be safe | Usual action |
|---|---|---|
| Red flags such as chest pain, severe breathlessness, signs of sepsis or new neurological symptoms | Needs examination, observations and often tests | Emergency or same-day in-person assessment |
| Diagnosis depends on examination, such as possible DVT, acute abdomen or a hot swollen joint | History alone cannot exclude serious causes | Arrange examination |
| Repeat contacts about the same problem | The patient may be deteriorating or the diagnosis may be wrong | Treat as a red flag and see the patient |
| Young children, frail older people, people who cannot describe symptoms clearly | Deterioration is harder to judge | Lower threshold for in-person review |
| Safeguarding concerns or the patient cannot speak freely | Someone may be listening or controlling the call | Arrange a safe in-person contact and follow safeguarding procedures |
| Language, hearing, cognitive or technology barriers | The history may be unreliable | Use an interpreter or see the patient |
| You are uncertain | Uncertainty means you need more information | See the patient or seek senior advice |
Which medicines need extra care when prescribed remotely?
Before prescribing remotely, ask whether you have enough information about history, medicines, allergies and results; whether identity is confirmed; whether the medicine is within your competence; whether remote assessment is adequate for this medicine; whether it could be misused or diverted; and who will monitor the patient.
- Medicines liable to misuse, overuse or dependence, such as opioids, benzodiazepines, gabapentinoids and other controlled drugs.
- Medicines that need close monitoring, such as anticoagulants, lithium or methotrexate.
- Medicines for long-term conditions where the patient's regular prescriber may not know about the new prescription.
- High-demand medicines sold through online services, such as those for weight management.
For these, you should normally have access to the patient's records and share information with their GP or regular prescriber, and be cautious about prescribing if you cannot. In February 2025 the GPhC published strengthened guidance for registered pharmacies providing services at a distance, responding to concerns about inappropriate online supply, including of weight management medicines. It requires information from online questionnaires to be verified and two-way communication between the person and the prescriber. Check the current GPhC, GMC and MHRA positions, because guidance in this area continues to develop.
What should a remote consultation record include?
Records matter even more in remote care, because the next clinician has no memory of how the patient looked or sounded. Your note should show what was asked, what was found, why you decided what you did and what the patient was told.
Tel consult. Cough 5/7. Likely viral. Advised fluids. Safety-net given.
Telephone consultation, identity confirmed (name, DOB), consented to remote consultation. Cough 5 days, green sputum, fever; no chest pain or haemoptysis. Speaking full sentences. Home temp 38.1, own oximeter 97 percent. Impression: likely viral lower respiratory infection, no features of pneumonia on information available. Plan: fluids, paracetamol, no antibiotic at present, reasons explained. Safety-net: call back same day if breathless, chest pain, confused, or not improving after 3 days; 999 if severe breathlessness or chest pain. Patient repeated advice back correctly.
The stronger note records the mode of consultation, identity and consent, relevant negatives, objective information, reasoning, and safety-netting with specific symptoms, timescales and routes. 'Safety-net given' on its own does not show what the patient heard.
Worked case: a missed escalation by telephone
Ravi, an advanced nurse practitioner in a busy surgery, picks up an online request from a 72-year-old man who wants stronger antibiotics four days into a course of amoxicillin for a chest infection. His daughter answers the phone and says he is a bit muddled and tired. The patient sounds short of breath but says he is fine. Ravi does not ask about observations or look closely at the earlier contact. He switches the antibiotic and says to call back if not better in a week. The next day the patient is admitted with sepsis and acute kidney injury. He recovers.
Several warning signs were present: treatment failure, a repeat contact, new confusion reported by a relative, breathlessness and older age. The patient needed same-day in-person assessment or emergency referral. The safety-netting given was vague and the timescale far too long. In his reflection, Ravi does not blame the workload. He describes accepting the patient's reassurance over his daughter's account, explains how he now reviews recent contacts and uses a sepsis prompt on every telephone contact with possible infection, and records how his remote consultations have since been reviewed by his supervising GP.
Strengthening your remote practice
Useful habits include reviewing a sample of your own remote consultations against the structure above, asking a colleague to listen to some calls, and checking that your organisation's policy on images, identity checks and high-risk medicines is one you actually follow. If you are involved in an incident, be open with the patient, report it and reflect honestly. If your regulator becomes involved, seek advice from your defence organisation, trade union or professional body before responding.
Our course Remote Consultation and Remote Prescribing explains the shared regulatory principles, a structured approach to telephone, video and online consultations, when to see a patient in person, safe prescribing of higher-risk medicines, and documentation, with worked examples and a guided reflection. It is written for doctors, nurses, pharmacists, paramedics and other prescribers working in remote or hybrid settings.
Frequently asked questions
Can a doctor prescribe over the phone in the UK?
Yes, when it is safe. Doctors can prescribe after a telephone or video consultation if they can make an adequate assessment, have enough information about the patient, including access to records where needed, and can arrange appropriate monitoring and follow-up. If the assessment cannot be done safely remotely, the patient should be seen in person or directed to another service.
Can nurses and pharmacists prescribe remotely?
Qualified nurse, pharmacist and other non-medical independent prescribers can prescribe remotely within their competence and scope of practice, following their regulator's standards and the shared high level principles for remote consultations and prescribing. The same duties apply: confirm identity, assess adequately, prescribe only when safe, share information with the patient's GP where appropriate, and keep clear records.
What medicines should not be prescribed remotely?
There is no single banned list, but regulators highlight medicines that need extra care: those liable to misuse or dependence such as opioids, benzodiazepines and gabapentinoids, medicines needing close monitoring such as anticoagulants, lithium and methotrexate, and high-demand medicines such as weight management treatments. For these you should normally have access to records and share information with the regular prescriber.
Do I need the patient's consent to tell their GP about a remote prescription?
The high level principles ask you to share relevant information with others involved in the patient's care unless the patient objects. Explain why sharing matters for safety. If a patient refuses consent for you to contact their GP when you are prescribing a medicine where this is important, you should consider whether it is safe to prescribe at all, and record your reasoning.
Can I ask a patient to send a photo?
Images can be very useful, for example for a rash or wound, but must be handled within your organisation's policy on consent, secure transfer and storage. Intimate images should not be requested unless your organisation's policy specifically allows it with appropriate safeguards. Record that consent was given and where the image is stored.
What should I document after a telephone consultation?
Record that it was a telephone consultation, how you confirmed identity, consent, the history including relevant negatives, any home observations, your reasoning and impression, the plan and prescriptions, the specific safety-netting advice with timescales and routes, and that the patient understood. Note who was present if a relative or interpreter was involved.
What if my online service pressures me to prescribe quickly?
You remain personally accountable for every prescription, whatever the service model. If you cannot make an adequate assessment, do not prescribe; signpost the patient to an appropriate service instead. Raise concerns about unsafe systems with the service, and if they are not addressed, with the relevant regulator, such as the CQC or GPhC. Keep a record of the concerns you raised.
Related courses
Remote Consultation and Remote Prescribing
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Sources and further reading
- High level principles for good practice in remote consultations and prescribing. General Medical Council and partner regulators.
- Good practice in proposing, prescribing, providing and managing medicines and devices. General Medical Council.
- Guidance for registered pharmacies providing pharmacy services at a distance, including on the internet. General Pharmaceutical Council.
- The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- A Competency Framework for all Prescribers. Royal Pharmaceutical Society.
- Standards of conduct, performance and ethics. Health and Care Professions Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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