SCA telephone consultations, without the visual cues

What an SCA telephone consultation is

Most SCA cases are video consultations, but some are audio only. The RCGP's SCA examination day guide explains how you will know: the case brief you read in the 3-minute window says whether it is a telephone consultation. If it is, you will not see the role player, and the screen shows an image of a telephone instead. You stay on video throughout, so the invigilator can still see you.

Nothing else changes. You get the same 12 minutes and the same three marking domains, and the examiner applies the same standard of a newly qualified GP. What changes is how you show your skills. On the phone, everything you do has to be heard to count: a nod, a sympathetic face or a moment of eye contact earns nothing. See how the SCA is marked for the domains in full.

What is different without visual cues

A structure for 12 minutes on the phone

This is our suggested structure, not an RCGP template. The timings are a guide for practice; real cases rarely split so neatly.

1. Opening (about 1 minute). Introduce yourself, confirm who you are speaking to and that they can talk privately. If the caller is not the patient, find out their relationship and whether the patient knows about the call.
2. Open history (2 to 3 minutes). Start broad and let them talk. Use short verbal encouragers in place of the nods you would give on video.
3. Focused questions and red flags (2 to 3 minutes). Signpost the change: “I'm going to ask some quicker questions now to make sure nothing serious is going on.” Ask about the things you would normally see, such as colour, breathing, rash or how alert a child is.
4. Ideas, concerns and expectations, woven in. Ask what they think is going on and what worried them enough to call, at the point it fits naturally.
5. Summary and explanation (about 2 minutes). Summarise aloud and check: “Have I got that right?” The summary does the job that eye contact does in the room.
6. Shared plan and safety-netting (3 to 4 minutes). Agree whether the patient needs to be seen, and when. Give specific safety-netting and ask the caller to repeat back the key points.

Examination when you cannot see the patient

You cannot examine on the phone, and you should not pretend to. What you can show is good judgement about it:

• Say what you would want to examine, and why. “I'd like to listen to his chest and check his oxygen level, because a cough with a fever and breathlessness can mean a chest infection.”
• Use what the caller can tell you. They can count breaths, describe a rash, press a glass on spots, check a temperature or read a home blood pressure monitor. Ask them to do it while you wait, and say why.
• Decide whether a face-to-face assessment is needed, and how soon: the same day, a routine appointment, or an emergency service if the history suggests it.
• Do not leave the gap unnamed. If you have managed without an examination, say why that is safe for this patient, and what would change your mind.

Safety-netting that works by phone

A telephone patient has nothing to look at afterwards, unless you send it. Safety-netting has to be specific, short and checked:

• Name the warning signs in plain words, not “if it gets worse”.
• Give a timescale: “If the fever is not settling by Thursday”.
• Give the route back: the practice, NHS 111 or 999, and which to use when.
• Check it landed. “Just so I know I've explained it well, what would make you call back?” This is not a test of the patient. It is how you check understanding when you cannot see their face.
• Offer written information, such as a text message or leaflet, where that would help.

Third-party callers

The RCGP's reasonable adjustments policy notes that while most cases involve the patient, some use a role player as a carer, parent or other health or social care worker. On the phone that is a common set-up: a daughter ringing about her father, a parent about a baby, a care-home nurse about a resident.

• Establish who they are and whether the patient is with them, knows about the call and is happy for you to talk.
• Think about consent and confidentiality before sharing anything about an adult patient. You can always listen; sharing is a separate decision.
• Ask to speak to the patient if they are there and able to, and explain why.
• Treat the caller's worry as real. A carer's own concerns, and their capacity to cope, are often part of the case.
• Keep safeguarding in mind when a professional calls about a child or an adult at risk.

Common pitfalls

• Talking too long without a check-in. Without visual feedback, a long explanation can lose the caller completely. Pause and check every few sentences.
• Forgetting to find out who is there. Discussing results with the wrong person is a professionalism problem, not just a communication slip.
• Treating phone cases as lower stakes. Missing that a child should be seen today is a clinical management failure, however good the rapport.
• Vague safety-netting. “Ring back if you're worried” gives the caller no idea what to watch for.
• Practising phone cases on video. Turn the camera off, or face away, when you practise. Otherwise you will rely on cues you will not have.

Practise telephone cases

Our bank includes 101 audio-only cases. In The Hot Seat, choose Telephone (audio-only) in the consultation-type filter, or browse the full case index. With a partner, sit back to back or turn cameras off. On your own, the AI Patient Simulator runs telephone cases by voice, so you practise without seeing anyone; read what AI marking can and cannot judge first. Mark each case in Examiner Marking, and include two or three phone cases in every mock exam.

Frequently asked questions

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