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GPs 'lack skills' for safe telephone consultations

Many GPs do not have the skills they need to ensure telephone consultations are safe, claim senior academics.

Changes to clinical guidelines and protocols and improved GP training are needed to keep pace with the massive expansion of telephone-based consultation, they suggest in an editorial in February's Quality and Safety in Health Care.

The editorial – written by Professor Martyn Partridge, professor of respiratory medicine at Imperial College London, Professor Aziz Sheikh, professor of primary care at the University of Edinburgh, and Dr Josip Car, clinical research fellow at Imperial College and a former GP – says clinicians fail to give adequate attention to safety and quality issues in phone consultations.

It adds: 'Future versions of guidelines, such as the BTS/ SIGN asthma guidelines, might include key questions to be asked during a telephone consultation.'

Dr Car said: 'There is considerable variability in quality – and consequently safety – of telephone consultations. Clinicians need guidance as to when and how to conduct telephone consultations.'

The researchers refer GPs to a set protocol aimed at improving the quality of phone consultations (see below).

Dr Nicholas Norwell, a medicolegal adviser for the Medical Defence Union, said problems did arise and urged GPs: 'Ask yourself – should this consultation be over the phone? If the answer is no, see the patient and examine them. If it is yes, always keep notes.'

Safe telephone consultation: advice to GPs

lAnswer the phone promptly, state your name, obtain the caller's name and phone number. Speak directly to the person who has the problem. Record the date and time of the call and the person's name, sex and age.

lTake a detailed structured history and then advise on treatment or other steps. Advise about follow-up and when to contact a doctor –

for example in the event of certain new or worsening symptoms, or failure to improve after a set time.

lSummarise the main points. Ask the caller to repeat the advice given and ask if they have outstanding questions. Let the caller disconnect first.

Source: Car and Sheikh, BMJ, May 2003

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