GP practice workload not reduced by telephone triage systems, research finds

Telephone triage systems in GP practices do not reduce the overall time clinicians spend with patients, a study by UK researchers has found.

GP telephone triage contact with patients lasted 4 minutes on average, the study found, while nurse triage calls lasted 6.6 minutes - well below the average length of a GP consultation.

But triaged patients were more likely than patients who visited the practice on the first contact to need subsequent consultations over the next 28 days, according to the study published in the BJGP.

Overall, total clinician time required was higher in practices using triage systems. Contact with clinicians for patients who attended a GP practice without prior telephone triage lasted 9.6 minutes on average, the study found. Patients triaged by a GP over the telephone took up 10.3 minutes overall of clinician time on average, and patients triaged by a nurse 14.8 minutes.

Overall 'health economic costs' were virtually identical for all of the models, the study found. 'There was no cost saving to the NHS afforded by telephone triage, and the workload appeared to have been redistributed rather than reduced,' the researchers wrote.

GP access

Despite the overall increase in clinician time required for nurse-led triage, this model did reduce GP time with patients, according to the study - which used data gathered from 42 GP practices in the ESTEEM trial.

GPs contributed 7.7 minutes of the overall average clinician contact time per patient in a nurse-led triage model, compared with 9.1 minutes in the standard care model and 9 minutes in the GP-led triage model.

The researchers said evidence suggested that telephone triage 'appears not to offer added efficiencty in terms of resource use than usual care'.

'Nurse-led triage, supported by decision-support software, is associated with a reduction in overall GP contact time...even though overall clinician contact time is increased compared with usual care. However, individual practices may wish to interpret the findings in the context of the available skill mix of clinicians.'

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