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A faulty production line

Offering phone consultations as standard 'could increase GP workload'

The telephone-first approach is not a cure-all solution to reducing GP workload and freeing up appointments, a study has found.

Asking patients to speak to a GP on the phone decreased the number of face-to-face consultations but increased the overall number of consultations by close to a third.

Researchers analysed data from 150 practices that adopted a telephone-first approach, where a GP speaks to a patient on the phone before offering them an appointment.

After the system was introduced, there was a 38% decrease in the number of face-to-face consultations but a 28% average increase in the total number of consultations. Around half of patients were asked to come in for a face-to-face appointment.

According to patient surveys, there was a large increase in patient satisfaction with the time taken to speak to a GP, corresponding to an average 20-point increase on a 0-100 point scale for satisfaction.

The authors of the study, published in the BMJ, also noted an increase in the time spent consulting, although this figure had a large degree of uncertainty.

They pointed out that the averages masked large variations between practices, with some experiencing double the amount of consultations and some having their overall number of consultations reduced by over two-thirds.

The paper said: ‘For clinicians, this study provides clear evidence that a considerable part of patient workload can be dealt with through phone consultations.

'This might increase the practice’s control over day-to-day workload but does not necessarily decrease the need for GP time and could increase it.’

RCGP chair Professor Helen Stokes-Lampard said: 'It is up to individual practices to decide what appointment booking or triage systems they implement to manage their workload most effectively for that particular patient, but we want to reassure patients that technology will not be replacing the work of GPs.

‘GPs are highly trained to take into account the physical, psychological and social factors potentially affecting a patient’s health and often these are non-verbal, so phone conversations will never replace face-to-face appointments completely.'

BMJ 2017; available online 27th September 

Readers' comments (12)

  • David Banner

    Phone consultations seem a good idea at first, but are rapidly abused by cannier entitled patients. Why go to the hassle of fighting for an appointment then trudging to surgery when you can have your fave GP on tap by phone? The result is a long stressful list of phone calls after a full surgery that are a medico-legal minefield

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  • Phone consutlations can decrease workload to start with - but patients soon realise and thenworried well will call 'just do advice' or just in case.

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  • Those figures mirror our findings.
    We have since reduced full open telephone access.

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  • Mr Mephisto

    What about Ask My GP? A recipe for disaster?

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  • Surely this is the Doctor First model - rather than additional phone calls. We have avoided this as it would appear to make every day and on call day. We do however run an Acute Service which involves triage by phone and seeing run by two doctors each day in a dedicated area. This makes the rest of the surgery more relaxed and the acute service is only one day - some GPs actually like doing it - I am ambivalent but it makes the rest of the week better and the patients like it.

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  • Neil Bhatia

    Phone calls are just another way of communicating with patients, particularly those who find it difficult coming to the surgery, or carers etc. They are a preferable alternative to a face to face consultation where one is not needed, especially for admin-related stuff, but they do not reduce total workload.

    I offer plenty of telephone appts, but my surgeries always get filled up anyway.

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  • The easier you make it for patient's to access the GP the more work you are going to have to do.
    Which is why email consultations, Skype consultations and Internet booking systems are also NOT a good idea.

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  • Try giving them all a flu jab over the phone! We waste ages trying to ring patient back on mobiles which then go straight to answerphone, jeopardy of a patient who may be ill that you can't get in touch with.

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  • Sticky plasters for temporary fix = tele,Skype etc. if the vain hope of tempering demand.

    Patient wants/demands, outstrip supply/need. It is amazing how many problems resolve themselves when it takes 2 weeks to see/speak to a doc. Which proves the point of wants vs needs vs pampering to impulsive health anxieties.

    NHSE talk about demand management...hmmm..... I am still trying to work out how practices are meant to stop patients ringing them up for appointments?

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  • Can someone tell Jeremy Hunt who things we can do all of this via an app.

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