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GPs buried under trusts' workload dump

Telephone-first approach not a solution to GP workload, says study

The telephone-first approach is not a solution to patient demand and GP workload, according to a new study. 

The method, whereby patients booking a GP appointment are initally phoned back on the same day by a GP, increases workload and does not suit all patients, the research found. 

Researchers reported that although the average number of face-to-face consultations decreased by 38%, there was a 12-fold increase in telephone consultations and an estimated 8% increase in overall time GPs spent consulting.

The report, by Cambridge Centre for Health Services Research, compared 146 practices using the telephone-first approach to practices that were not using this method. The study’s authors surveyed 42 practice managers and 873 patients, all of whom recently had a telephone consultation with a GP.

The most common disadvantage of the system among practice managers' responses was 'increased/more intense workload for GPs and more stress'.  

The survey also found that 44% of patient respondents said the method was either less convenient or made no difference to them. 

Though some patients were positive about the convenience of the telephone-first approach, which reduced the need to come into the surgery, others said it was difficult for them to answer a GP's call if they were at work, and those whose first language was not English said the method was a problem.

The report said: 'It is clear from this and other studies that telephone consulting forms a useful part of the services that a practice offers to patients, and it is also clear from our results that a substantial amount of GPs’ workload and patients’ problems can be dealt with on the telephone. However, neither telephone triage nor the telephone-first approach evaluated here are a solution to meeting demand for care in general practice.'

RAND Europe's Dr Jennifer Newbould, one of the study's authors, said: 'We know in some cases that clinical commissioning groups have funded use of a telephone-first approach as a way to support struggling practices. However, our research suggests that practices without appropriate capacity and capability may struggle implementing the approach and this can have a very negative impact on staff morale.'

The study also analysed hospital utilisation data and concluded that telephone triage led to a 2% increase in hospital admissions, and there was no evidence in the report that the telephone-first method would reduce secondary costs.

Prof Martin Roland, who led the research, said: ‘Our study of a telephone-first approach shows that a number of issues can be resolved with use of telephone consultations in primary care, but the challenge of meeting patient demand remains a major issue for many general practices.’

Previous research warned that offering telephone appointments as standard ‘could increase GP workload.’

However, other studies have suggested that some patients prefer phone consultations over face-to-face appointments.

Readers' comments (8)

  • Increasing supply does not reduce demand in a free all you can eat health care system who'd have thunk it FFS.

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  • Dear All,
    Oh dear what a surprise. Not as if it hasn't been shown before. "some patients prefer phone consultations" so lets provide phone consultations. Others like home visits so lets provide home visits. Some like Skype consults so lets provide those. Some like e-mail exchanges so lets provide those. Some like to send letters so lets answer those as well. Some actually like to sit face to face with their doctor, lets provide that as well. In fact lets provide everything everyone wants, everywhere, all the time.
    When will they learn? to survive in a resource limited system you need to match access to supply. No is a complete sentence.
    Regards
    Paul C

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  • as above, well said. agenda to provide everything all the time. political win but unfortunately comes at a cost which we are currently seeing.
    bring on AI/bot consultations so we can all be out of a job and released from this current mess.

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  • Well said @ Paul Cundy
    Consumerism versus need based system,
    Knee jerk reaction to market force (Babylon) versus well thought through holistic care,
    The Politicians promised 5K additional GPs!Where are they?
    We hear the solution is -provide more services by variety of new avenues - Wake up and smell the coffee!

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  • Well said paul cundy. The patients need to know it is rationalised healthcare and not
    "best" healthcare. The government must provide the resources to meet the expectations they stoke up. We cannot end up being the fall guy.

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  • if we all refused to provide the endless phone calls and limited it to a maximum per day, redirect patients to 111 and A^E when full, something would be done. by taking the excessive workload we destroy general practice and ourselves. we do no one any favours by absorbing more and more work unpaid and without enough staff. time to stop.

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  • The reality is that telephone triage simply tells you which patients didn't actually want to be seen in the first place. Even the urtis come back a few days / weeks later when they have earned their appointment. I never believed that telephone triage would reduce demand, but what it does do is make it slightly harder for a patient to see a GP and makes them work harder, and possibly appreciate the service when they get it ? Naive?

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  • Well said Paul C!

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