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I just wanted to talk briefly about the process of doing the telephone triage and actually documentation of the consultation. We use the Adastra platform and it is exactly the same as though we were doing a face-to-face consultation. However, obtaining the information is slightly different as we have already discussed. What we do is we populate the history part of the screen using the medical model. Prior to doing that, we would introduce ourself to the patient, we would get the patient to confirm their name and date of birth so we would know we have got the right notes in front of, which we do not want to be entering documentation on the incorrect screen and then make sure the patient's happy with myself doing the consultation introducing myself and my position within the organisation.

Once we have identified the patient's give consent, what we would do then is I would ask for a history of the presenting complaint, document within the history screen. I need to know what their main concern is today, why they are ringing the service. It is also worth knowing about their previous or past medical history. It may influence what the problem is today. Need to know about the medications, particularly in the elderly. They may not be aware of what conditions they have got, but once they tell you about what medications they are on, you can sort of determine what conditions they are being treated for.

It is important we know about allergy status, particularly if we are going to issue any medications and it is good to know about social history as well. Do they live alone? Do they have any carers visit? If so, how often do they come in? Are they cared for by relatives or friends? Are they living at home? What is their mobility like? Are they in a care home? Is it residential or nursing? It is just worth getting as much information as possible.

Once we have populated all this, below this bit then we can actually discuss what we have elicited from the consultation and what we plan to do. Down in the bottom box in the treatment area, we can actually then need to document anything that we have discussed with the patient or the carer. So if we give self-care advice, we need to explain about over-the-counter medications such as pain relief. We need to discuss potential side effects if we are prescribing any medications such as antibiotics. If we are giving advice about managing fevers, if we are giving advice about increasing fluids, how often to do it. And then one of the important things is explaining about safety netting and red flag warning signs to look out for.

So safety netting could be if your symptoms do not resolve in the next two days or you start becoming feeling worse, you need to seek further medical advice via your own GP or by ringing 111. If anything significant changes and you are grossly unwell, you must ring 999, or go to the local Emergency Department. When you're talking about red flags, it is specific to their presenting complaint. So if somebody has rung up with a possible infection, you need to tell them about the possible red flag signs associated with sepsis. So we would need to look for sudden acute confusion, collapse, an increase in fever, a high pulse rate, looking grossly unwell. These are all red flag warning signs that we need to make the patient aware of.

And at the end of the conversation, what we need to make sure is the patient understands what the plan is and they agree with it, so it is always important to put "patient understands the plan and agrees with this". It shows that you have involved the patient in the decision-making process at the end, it is very important. Once we have done that, we can then close the case. If we need to prescribe, we can do it via the appropriate service, either via electronic prescribing or we can send a prescription to a local pharmacy. Always good then to know beforehand which pharmacy the patient would normally use.

However, in the out of hours period, it may not be appropriate. Their pharmacy might not be open, and they would need to go to the nearest pharmacy that is open within that period. And once you are done, you can confirm all your notes, make sure it is all tidy and you are happy with it before you submit it. And then you can result that either as self-care or as a centre visit or as a home visit, depending on what was discussed in the consultation process.