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a woman on phone to gp imageSeptember 29 2017

Telephone triage services in general practice may not reduce overall GP workload or reduce secondary care usage, a new BMJ study has concluded.

 Data from 147 general practices adopting the telephone first approach, and compared with a 10% random sample of other practices in England, found that:

  • face to face consultations decreased 38% after the introduction of the telephone first approach;
  • the average duration of both telephone and face to face consultations decreased, but there was an overall increase of 8% in the mean time spent consulting by GPs;
  • practices using the telephone first approach saw a 20.0 percentage points improvement in length of time to be seen, compared with other English practices.

“The telephone first approach shows that many problems in general practice can be dealt with over the phone,” said the researchers. However, they concluded: “The approach does not suit all patients or practices and is not a panacea for meeting demand. There was no evidence to support claims that the approach would, on average, save costs or reduce use of secondary care.”

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

“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,” she added.

“GPs are highly trained to take into account the physical, psychological and social factors potentially affecting a patient's health and often these are non-verbal, so phone conversations will never replace face-to-face appointments completely.”

Links:
BMJ announcement       
J Newbold et al. ‘Evaluation of telephone first approach to demand management in English general practice: observational study’. BMJ 2017;358:j4197                  

RCGP comment                   http://www.rcgp.org.uk/news/2017/september/telephone-triage-can-be-useful-but-doesnt-necessarily-reduce-gp-workload.aspx

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