Triaging patients using 'telephone first' approach may increase GP workload

A telephone first approach in general practice is likely to increase overall GP workload and there is 'no evidence' that using the scheme saves money, researchers have found.

Triaging all patients over the phone before booking appointments is 'no panacea for meeting demand' in general practice, according to the BMJ study.

Researchers analysed data from 147 GP practices in England using the approach and compared them with a 10% random sample of other practices in England. They also reviewed responses to patient satisfaction surveys.

In 'telephone first' practices GPs speak to all patients on the telephone initially to decide whether the problem can be resolved there, if a face-to-face appointment is needed, or if seeing another professional such as a nurse or pharmacist may be more appropriate.

The researchers found adoption of the approach led to fewer face-to-face consultations – from a mean of 13 to nine per day per 1,000 patients – and more telephone calls – from a mean of three to 12 per day per 1,000 patients.

These results suggest that much of the work of a GP can be managed on the telephone, they concluded, but almost half of the patients triaged needed to be seen in person – effectively doubling the length of time for a GP to deal with their problem.

Telephone first

The study, commissioned by the National Institute for Health Research, found wide variation among practices in how the system impacted GPs – but showed overall it was associated with increased workload.

Patient responses to the scheme were also mixed, with some welcoming that they could be seen more quickly in telephone first practices, and others finding it more difficult communicating over the phone.

The scheme also led to an increase in emergency admissions, which the researchers warned could increase overall costs to the health system.

But they added that no firm conclusions could be drawn about cause and effect from the study – although they said it appears the scheme ‘does not suit all patients and is no panacea for meeting demand’.

RCGP chair Professor Helen Stokes-Lampard said: ‘Telephone consultations can be convenient – and they certainly can help direct patients to the most appropriate care for their health needs.

GP workload

‘But as this research has shown they don’t necessarily reduce GP workload in the end as 10 minutes are 10 minutes whether spent speaking to patients over the phone or face-to-face. And, if as a result of the phone conversation follow-up action is needed for that patient, then this actually may increase the GP’s workload.

‘GPs and our teams are delivering more than 1m patient consultations every day – and recent research shows that our workload has increased 16% over the past seven years. Yet, investment in our service has declined over the last decade and our workforce has not risen in pace with demand.

‘It is up to individual practices to decide what appointment booking or triage systems they implement to manage their workload most effectively for that particular patient, but we want to reassure patients that technology will not be replacing the work of GPs.

‘Ultimately, we need the pledges made in NHS England’s GP Forward View – including £2.4bn more a year for general practice, 5,000 more GPs and 5,000 more members of the wider practice team by 2020 – delivered in full and as a matter of urgency.’

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