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At the heart of general practice since 1960

Choosing a practice telephone system

Practices often neglect to check the cost-effectiveness and efficiency of their telephone systems and can lose money and patient support as a result, says Dr Peter Saul

Access to an effective phone system at the surgery has become increasingly important to both practice staff and to patients. Yet while computer systems get upgraded or changed almost on a yearly basis it can be a decade or more since the phone system was looked at.

A review of this essential piece of surgery equipment may be timely and could increase efficiency and produce savings.

The first step is to examine what is needed by the practice. Are there sufficient exchange lines to allow reasonable access for patients and to allow staff to dial out when they want? Do you have sufficient numbers of extensions and are they in the right places? Can the system do what you want it to and what you are likely to need it to do in the future?

Because our main business is managing people's health, it is useful to get some professional advice here. Telephone systems installers will be only too pleased to provide free reviews and a quote for the practice's potential needs, probably identifying useful functions which could not otherwise be envisaged.

It's best to get two or three such reviews, and rely on word-of-mouth recommendations from colleagues in selecting a company experienced in dealing with GPs.

Incoming calls pose a dilemma. The real limit on these is the number of people available and the time taken to answer them. Old-fashioned systems 'dump' all of these at reception and callers either get through or get a busy tone.

Offering a choice to callers

The disadvantage here is that callers can't prioritise their need, for example they need urgent advice rather than merely requesting an appointment. They may have to waste time calling back repeatedly and get annoyed in doing so.

Newer systems allow the phone to be answered with a recorded message and offer callers a choice of options with call queuing, and the ability to 'prioritise', until a receptionist becomes available. The disadvantage here is that callers have to pay for holding and may have no idea how long they will have to wait.

GPs will be familiar with this from the last time they called a utility company! Additionally some of the menu systems used can be complicated and difficult to navigate for an individual who is stressed or maybe a little confused. The best plan is to get a system which has the ability to automatically direct and queue calls and to try it out, soliciting feedback from patients.

Whatever the number of lines coming into the practice it is possible to reserve some for outgoing calls to ensure that however busy it is, you can always dial out. It is also possible to allocate additional numbers for specific extensions. For example, there may be four exchange lines, and although no more than this number of calls can be simultaneously handled, you could have as many different numbers routing to specific extensions as you want.

This can effectively give secretarial and management staff their own 'private' number, allowing calls to bypass the switchboard.

Other facilities to look for include the ability to 'forward' calls when the practice is unstaffed. Here the system answers the call, announces the practice is closed and invites the caller to a button if they want to be connected to the out-of-hours provider.

This system has the bonus of gaining the QOF point for single number access. The NHS will increasingly be moving to sending voice traffic over data networks, so-called 'VOIP'. Most new systems will be able to manage this with at most a minor upgrade.

A typical system from BT meeting these requirements for a small to medium-sized practice with four lines and a dozen extensions would cost just over £2,000 to purchase. This would only include two switchboard-type phones and does not include the cost of fitting new extensions or the standard phones for existing extensions.

Sophisticated queuing

NEG, the company that offers 'Surgeryline', leases its products. A similar system – but offering additional facilities such as voice recording, more sophisticated queuing and including all necessary wiring and extension phones as well as cordless headsets – would cost around £200 a month including maintenance.

The company offers a different approach with numbers – the practice changes to an 0844 number for patients to call. This is a non-geographic number which means there can be an unlimited 'virtual' queue of callers for however many lines the practice has.

The practice earns 2p per call for every one received, which can offset the lease cost. This is clearly a very sophisticated system offering good access for patients.

There is a downside because inward call costs are higher, particularly for patients using bundled call tariffs from either a mobile or fixed line.

Ofcom, the telecoms regulator, is set to introduce '03' numbers which offer the same versatility as the 0844 number but are treated as 'ordinary' numbers for billing purposes. Somewhat hypocritically (check the numbers for the DVLA, the Passport Office and of course NHS Direct) the Government is keen for GPs to use these when they are available.

A big decision when installing a new system is whether to lease or buy outright. Even with outright purchases there will be a maintenance cost payable each year. Straight purchases may be partially funded with an improvement grant, or possibly with drug incentive payments, although leasing may be kinder on cash-flow initially.

Once you have decided upon a system, you should consider which network provider to use. BT is often not the cheapest, so shop around. Include Cable and Wireless (which can offer cheap calls to many NHS sites) and Opal Telecom (part of Carphone Warehouse) in your inquires.

Remember that calls using 18866 are capped at 5p each, however long. Impress upon staff the need to encourage patients with mobile numbers to call you back rather than returning expensive calls to them.

Assessing your phone system and future needs is really a team effort, where the views of the reception staff and practice manager are often more relevant than those of the doctors. Make the right choice and everybody's life, including the patients, is made easier.

Peter Saul is a GP in Rhos near Wrexham

Needs checklist

• Number of incoming lines

• Extensions – how many

and where (consider cordless phones)

• Queuing capacity

• Answer and call routing

• Direct numbers to staff

• Diversion of OOH calls

• Integration of fax machine

• Call recording

• Buy or lease

• How popular with staff?

Where to go

Phone system suppliers

• NEG 0800 111 6606

• BT Phone Systems 0800 389 4848

• Midland Communications

0800 7313 007

Network providers

• www2.bt.com/health/

• www.cw.com/uk/public_sector/nhs_ solution_centre/

• www.opaltelecom.co.uk/

• www.call18866.co.uk/

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