The ESTEEM study took two years and over 40 practices to show that operating a telephone triage system increases workload in the 7,000 telephone consultations recorded.
The study itself is not a bad one; good method, good statistics, with results that are not exactly surprising and its conclusions are valid. You could quibble that looking at same-day service requests, excluding children and practices which have already adopted advanced access is narrowing the field, and that practices which take on such an initiative as part of a randomised trial might not really buy in to the changes required to operate clinical triage, but that would be, as I say, quibbling.
It is too rigorous a study to have real world application
The trouble is it is not news, other studies have reached similar conclusions in varying ways.
What made the study newsworthy is the government’s current push towards varying methods of access at a time when the profession is under-resourced and under pressure.
Put aside the political context for a moment and this study does have value. It provides a benchmark for follow up after a same-day service request, but other than that it is too rigorous a study to have real world application.
We should not take the study as saying telephone access will not work for some
My practice went live with a homegrown model of advanced access at the beginning of July. Already we have 3,000 real world telephone contacts with 25% of our 12,500 patient list, in just one month.
In two months we will have as much experience as the study-generated evidence in two years.
Granted, there are confounding factors galore in my practice; a committed team of medics with a large number of younger medics who are happy to do things differently, keen receptionists, a really low level of patient satisfaction with the old system, and a population which previously enjoyed a turn-up-and-wait appointment system until government diktat abolished it.
Of course I would not dream of suggesting that our way would work for everyone, that would be silly, but equally we should not take the ESTEEM study as saying that telephone access will not work for some.
We have never had one-size-fits-all general practice, despite contractual drivers, and in some places with certain features, it will be the right thing to do.
- Dr Chris Mimnagh is a GP and co-director of clincial strategy at Liverpool Health Partners.