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Consultations longer in GP practices with nurse triage

Running a nurse triage system to divert patients with minor illness away from GPs leads to a significant increase in consultation lengths, research finds.

The study into the use of nurses to handle lesser cases found patients who eventually saw a GP presented with more problems than those in practices that operated a standard same-day appointments system.

GPs at the three practice sites studied also gave more prescriptions and carried out more investigations per patient. Referrals to secondary care were unaffected.

The research, published in the British Journal of General Practice this month, concluded: 'Changes to the mixture of skills in primary care may result in the need for GPs to change their consulting behaviours to accommodate an increase in the number of problems presented per patient.'

It also recommended practices increase the length of slots to cope with the added complexity of each consultation.

Study author Dr Joan Meakins, a GP at the nine-partner multi-site practice in York, said GPs found they had to spend at least 10 minutes with patients to give appropriate care. She added the scheme would have cut GP workload if the practice size had remained constant.

'The practice size increased while we were doing the trial, so we had to rationalise the doctors' time more effectively,' she said. 'If it hadn't increased, then we would have seen a reduction in workload.'

The study found nurses were able to deal with around 40 per cent of patients who would have been seen by a GP.

Dr Bev Turner, a GP in Dronfield, Derbyshire, said the average consultation length at her practice had risen to more than 14 minutes during the two years it had been running a nurse triage system.

The practice has changed its appointment system to allocate a period at the end of normal surgery for triaged patients. Dr Turner added patients had also changed their behaviour.

'They are now aware that they can speak to the nurse about their problems, and many can do it over the phone,' she added.

By Jacqueline Head

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