SCA telephone and video consultations: how to run a remote case
Every SCA case is a remote consultation. The RCGP says: "In the majority of these you will be able to see the simulated patient. Others will be audio only." The RCGP pages we read don't say how many of each. Physical examination isn't assessed, but the RCGP's SCA toolkit notes that "a few examinations can be done either on the telephone or during a remote video consultation, such as tests of cognitive functioning and mental health including suicidal risk assessment." The skills that pass a remote case are the same three domains, done with extra care for cues you can only hear, identity and safety, and a safety-net the patient can repeat back.
Last checked Nov 1, 2026 against the RCGP and GMC pages listed under Sources.
The short version
- All 12 cases are remote: most on video, some audio only (RCGP). The RCGP pages we read don't give the split.
- You sit it in a GP surgery through the Osler platform, usually your own surgery (RCGP).
- No physical examination is assessed. Some assessments work remotely: cognitive testing and mental health, including suicide risk (RCGP SCA toolkit).
- On the phone, the main formal examination is the mental state examination, and the toolkit says you can "often gain valuable information from listening carefully to the patient over the phone."
- The GMC's remote consultation principles apply: identity, vulnerability, saying who you are, prescribing only when it is safe, adequate assessment, clear information, after-care and notes.
- Safety-netting carries more weight remotely: you can't see them leave the room, so make the safety-net specific and check it back.
What the RCGP says about remote cases
From the RCGP's SCA pages:
- "There will be twelve consultations with simulated patients, each lasting twelve minutes." "In the majority of these you will be able to see the simulated patient. Others will be audio only."
- "Candidates will take the SCA in a local GP surgery via the Osler examination platform. In most cases, this will be your own surgery."
- "Physical examinations will not be assessed within the SCA, and instead will be covered within WPBA."
- From the SCA toolkit (Data gathering): "A few examinations can be done either on the telephone or during a remote video consultation, such as tests of cognitive functioning and mental health including suicidal risk assessment." And: "The main formal examination type in an audio consultation is the mental state examination. However, you can often gain valuable information from listening carefully to the patient over the phone."
The toolkit also covers interpreting examination findings and tests ("Interprets appropriate examination and tests"), which in a remote case often means results or information in the case notes.
Telephone skills are assessed in training too: the RCGP's workplace-based assessment includes an Audio-COT, which "provides an additional tool to enable the assessment of your telephone consultation skills". Your recorded or observed phone consultations at work are good practice material for the SCA's audio-only cases.
Video vs audio only: what changes
| Video case | Audio-only case | |
|---|---|---|
| What you have | Face, body language, the room, sometimes something they show you | Voice only: tone, pace, pauses, breathing, background noise |
| Rapport | Eye contact with the camera, nodding, open posture | Say out loud what a nod would say ("I'm listening, go on") |
| Cues | Facial expression, tearfulness, looking away | Hesitation, a change in voice, a long silence, a half-finished sentence |
| Examination | Observation; what they can show you; cognitive or mental state assessment | Mental state examination by conversation; what you can hear |
| Risk | You can see if someone else is in the room | Ask: "Is anyone with you? Is this a good time to talk privately?" |
| Explaining | You can see confusion and slow down | Chunk, then check: "Does that make sense so far?" |
| Safety-net | Same content; check understanding | Ask them to repeat it back; they can't read your face |
The GMC's principles for remote consultations
The GMC's "Remote prescribing high level principles" (for consultations by phone, video or online) set out what good practice looks like. In short, clinicians should:
- Make patient safety the first priority, including checking identity.
- Understand how to identify vulnerable patients.
- Tell patients their name and role, and establish a dialogue.
- Prescribe only when it is safe; it isn't safe without sufficient information.
- Get informed consent and follow the law on capacity.
- Do an adequate clinical assessment and access medical records or verify important information.
- Give clear information about all the options.
- Make appropriate arrangements for after-care.
- Keep notes that fully explain and justify decisions.
- Stay up to date with relevant training.
In an SCA case most of these show up as one or two sentences: confirming who you are speaking to, saying who you are, asking where they are and who is with them if risk is possible, and saying plainly when you need to see them in person instead.
When a remote case needs a face-to-face plan
The RCGP doesn't assess physical examination in the SCA, but your plan can still include one. If you couldn't safely manage the problem without an examination or test, saying so and arranging it (today, with a time) is good clinical management, not a failure of the remote consultation. Saying "I'd like to see you today at 4pm so I can examine your tummy" beats guessing.
Worked example: an audio-only mental health case
Example written by Confetto for practice (not a real RCGP exam case). Clinical content follows NICE guideline NG222 (depression in adults) as of November 2026; follow local crisis pathways in practice.
Case notes (what you read in the 3 minutes)
Ryan Clarke, 36. Telephone consultation, booked by the patient: "can't sleep". Past history: none recorded. Medicines: none. Alcohol last recorded 4 years ago: 10 units a week. No consultations in the last year.
The patient's brief (hidden from you)
- Story: sleeping badly for 6 weeks since being made redundant. Low mood, no energy, has stopped seeing friends.
- Cue 1: "Sometimes I think everyone would be better off without me." (Said quietly, after a pause.)
- If asked directly and kindly: has had thoughts of not wanting to wake up, no plan, no preparations, has not acted on them. His 7-year-old daughter is a strong reason to keep going. Drinking 4–5 cans of beer most nights to sleep.
- Ideas: "It's just stress, I need to sleep."
- Concerns: that he is "weak", and that if he says too much "someone will take my daughter away".
- Expectations: sleeping tablets.
- If the doctor jumps to prescribing: he agrees quickly and doesn't mention the thoughts.
A 12-minute outline that would score well
| Time | What the doctor does | Example line (written by Confetto) |
|---|---|---|
| 0:00–1:00 | Introduces self, confirms identity, checks he can talk privately and where he is | "Before we start, can I check your date of birth? And are you somewhere you can talk privately?" |
| 1:00–3:30 | Open question, lets him talk, hears the cue and the pause | "You went quiet just then. What's been going through your mind?" |
| 3:30–6:00 | Mood, sleep, alcohol, then a direct, calm risk assessment: thoughts, plans, actions, protective factors | "Some people who feel this low have thoughts of ending their life. Have you had thoughts like that?" |
| 6:00–6:30 | Picks up the hidden concern about his daughter | "You mentioned your daughter. Is anything worrying you about her?" |
| 6:30–7:30 | Shares the working diagnosis in plain words and addresses the concern | "It sounds like this is more than stress: it sounds like depression, which is common and treatable. Talking about it today is the opposite of weak." |
| 7:30–10:30 | Options: talking therapy (including self-referral to NHS Talking Therapies), sleep and alcohol, medication as a choice; explains why sleeping tablets aren't the best answer now; agrees a plan | "Sleeping tablets with alcohol can be risky and don't fix what's keeping you awake. Can we look at what would help the low mood?" |
| 10:30–12:00 | Crisis plan and follow-up, with teach-back | "If the thoughts get stronger or you feel you might act on them, call 999 or go to A&E. You can also call NHS 111 or Samaritans on 116 123 any time. I'll call you again in a week. Can you tell me what you'd do if things got worse tonight?" |
What scores in each domain (example marking, written by Confetto)
| Domain | What a pass looks like here | RCGP toolkit item | What would earn a fail, and the RCGP feedback statement it matches |
|---|---|---|---|
| Data gathering and diagnosis | Hears the cue, asks about suicidal thoughts directly, asks about plans, alcohol and protective factors; reaches a working diagnosis of depression with risk assessed | "Identifies cues"; "Rules in / out a serious disease"; "Reaches a working diagnosis and/or analysis" | No risk questions: "Data gathering was insufficient to enable safe assessment of the condition/situation" |
| Clinical management and medical complexity | No sleeping tablets on a first call with alcohol and suicidal thoughts; talking therapy and self-help offered; alcohol addressed; follow-up within a week; specific crisis safety-net | "Offers a safe patient-centred management plan"; "Provides follow-up / safety net" | Prescribes a hypnotic and ends the call: "The plan relating to the medical management of risk was inadequate or inappropriate" |
| Relating to others | Calm, non-judgmental tone; uses silence; responds to "weak" and to his fear about his daughter; agrees the plan with him | "Listens and shows curiosity"; "Clarifies and explores cues offered"; "Supports in decision-making" | Ignores the cue twice: "Communication skills, including the non-verbal, responding to cues and/or active listening were insufficiently demonstrated" |
Why this case works on the phone
The key cue is a pause and a quiet sentence. On video you might also see it; on the phone you only hear it. The candidate who says "You went quiet just then" turns a fail into a pass.
Phrase bank for remote cases (written by Confetto)
| Moment | Phrase |
|---|---|
| Opening | "Hello, I'm Dr …, one of the GPs. Can I check I'm speaking to …? Is now a good time to talk privately?" |
| Location (if risk) | "Just so I know, where are you at the moment?" |
| Showing you are listening (audio) | "Mm, go on." / "I'm still here, take your time." |
| A cue you heard | "You sounded worried when you mentioned …" |
| Asking to see something (video) | "Could you hold that closer to the camera?" |
| Signposting | "I'm going to ask a few quick questions to make sure this isn't anything serious." |
| Checking understanding | "I've said quite a lot. What will you tell your partner about today?" |
| Needing to see them | "I can't examine you over the phone, and I'd like to, so let's get you in today." |
| Safety-net with teach-back | "So you're clear: if … happens, you'll … . Can you say that back to me?" |
Practice this case with an AI patient
Confetto isn't affiliated with the RCGP.
Frequently asked questions
Are SCA cases on the phone or on video?
Both. The RCGP says that in the majority you will be able to see the simulated patient, and others will be audio only.
How many SCA cases are telephone consultations?
The RCGP pages we read don't give a number, only that most cases are video and others audio only. Prepare for audio-only cases as a normal part of the exam.
Can I examine the patient in a remote SCA case?
Physical examination isn't assessed in the SCA. The RCGP's toolkit says some examinations can be done remotely, such as tests of cognitive function and mental health including suicide risk assessment.
Do I need to check the patient's identity in the SCA?
The GMC's remote consultation principles put patient safety first, including identity checks. Doing it briefly at the start shows safe remote practice.
What if I need to examine the patient to be safe?
Say so and arrange it. Planning a face-to-face review is part of a safe plan, and the GMC's principles say not to prescribe without sufficient information.
Where do I sit the remote SCA?
In a local GP surgery via the Osler platform; in most cases your own surgery (RCGP).
Sources
Read on November 1, 2026.
- Introducing the SCA, RCGP
- Applying for the SCA, RCGP
- SCA toolkit: Data gathering, RCGP
- SCA toolkit: Relating to others, RCGP
- Feedback statements for the SCA, RCGP
- Workplace Based Assessment (WPBA), RCGP
- Remote prescribing high level principles, GMC
- Depression in adults: treatment and management (NG222), NICE