Telephone triage can cut 60% of the cost of your GP consultations, but it is easy to get wrong, says expert Sally-Anne Pygall
With rising patient expectations, practices are commonly using telephone triage to manage requests for appointments and to help meet access targets.
Telephone triage can improve patient adherence to treatment and outcomes and save practices time and money. But new research has raised questions over its use for acute illnesses and whether phone consultations include sufficient information to exclude serious illness [1,2].
The message from these trials is that telephone triage has to be done with the right people and systems in place. Problems often crop up when triage systems are introduced without enough preparation.
Here I will explain what factors you need to consider before bringing in a new telephone triage system in your practice.
Choosing the right model
There are a variety of telephone triage models to choose from. Your choice will depend on your staff, patients and the IT/telephone system in place. You can use telephone triage for every appointment (such as the Stour Access System3) or just for same-day appointments or requests for home visits.
Do you want to use GPs, nurses or a mixture of both? Triage services that use receptionists can work well, but not all patients are comfortable speaking with a non-clinician. Receptionists may also take longer on calls (as they may need to ask more questions) and so staff capacity will need to be considered.
How will the service work? An IT-based clinical decision support system (CDSS) is useful, but it costs more and may not be popular with GPs. Clear practice protocols can be cheaper, more flexible and still provide the same support as a CDSS.
Your telephone system must be appropriate for the amount of triage your surgery wants to do. If lines are going to be tied up with triage calls, you may need additional outgoing and incoming lines for routine calls.
How will you audit the quality of the service? Recording is one of the best ways of quality-assuring telephone triage. It can also be used for appraisals and clinical supervision of nurses. In the event of a complaint, recordings can help to support clinicians. If your current telephone system does not have a recording mechanism, it is a good idea to consider updating it.
Before implementing any telephone triage system, it may be useful to consult an expert and carry out a needs analysis or risk assessment of your planned service.
Costs
There are clear monetary benefits to using telephone consultations (see table below), rather than face-to-face consultations or visits, but it will only be a cost-effective
if it is done appropriately by clinicians who are confident and proficient in this skill area.
Training costs should be factored into your calculations. Overall, the cost of implementing a triage system will depend on the model you choose, your existing telephone and IT system and the level of training staff require.
Primary care organisations may be able to assist through protected learning time and updating telephone systems. Additional costs will occur in the form of communication with patients.
Staff training
Managing patients over the phone is significantly different from face-to-face care and not everyone has the right aptitude and skills to do it well.
Good triage training will equip GPs or nurses with the skills to handle the uncertainty of sensory deprivation and give information on how to communicate effectively and manage any clinical or legal risk. There are a few companies that provide this kind of training. A course for 15 people can cost in the region of £30 per person.
Training on communication skills and to ‘signpost' correctly is vital for receptionists. Consider a triage protocol to reduce the risk of missing information vital to the clinical triage. It's a good idea to have a script for the receptionists to follow at first.
Legal risk
Telephone triage is now an accepted form of remote assessment and the legal aspects of this work are the same as any other form of nursing or medical practice.
There is a lack of specific guidance when it comes to telephone triage but you need to be aware of the GMC guidance on the recording and storage of audio recordings [4]. The Nursing and Midwifery Council states staff must have the knowledge and skills for safe and effective practice when working without direct supervision [5].
Third-party calls are common in telephone triage and this particular risk can be managed by practice protocols and effective training.
Nursing staff can be an excellent resource for managing demand for GP appointments but practices must provide adequate clinical supervision for professional accountability. Voice recordings can help with this.
Communicating with patients
Research indicates patients are happy to accept telephone triage.6 The key, though, when implementing a new system is clear communication and engagement.
Consider writing to patients informing of them of when it is going to be implemented, why and by whom. Let them know that the receptionist's role may change and to expect more questions to ensure they receive the right care.
If you have a recorded message, use this to tell them of what is going to happen – use a well-known GP's voice to record the message as patients are more likely to take notice.
Sally-Anne Pygall is a nurse and director of training company Telephone Consultation Services. For more information go to www.telephoneconsultationservices.co.uk
Cost of GP contact
Telephone consultation: 7.1 mins, £21.30
Face-to-face appointment only: 11.2 mins, £33.60
Home visit only: 11.4 mins (excludes 12 minutes travel time), £58.14
Source: Personal Social Services Research Unit
How to set up telephone triage without alienating your patients Case study
