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Wednesday 23 May 2012
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GPs hail 'staggering' success of new access model

By Gareth Iacobucci | 10 Oct 2011

An innovative new access model using GPs to triage patients over the telephone before they are booked an appointment can dramatically increase capacity at surgeries and ease pressures on A&E, a new study suggests.

Practices offering patients brief GP telephone consultations promptly after initial contact saw their A&E use fall by an average of average of 20%, increases in through-flow of patients and falls in DNAs.

Most triaging conversations lasted less than three minutes, and only a third of patients then required a face-to-face appointment with a GP.

The method is being hailed by researchers as a potential breakthrough in the long-running drive to improve patient access, which led to flawed experiments with the Advanced Access model.

The research was carried out by Patient Access, a social enterprise set up by GPs. It claimed the findings - circulated across the health service by NHS Primary Care Commissioning – could save the NHS £200m in England alone if adopted nationwide.

Under the Patient Access method, patients telephone their practice, and GPs then call them back as soon as possible, with an emphasis on dealing with the problem the same day if the patient wishes.

The analysis examined data from 40 practices. Detailed evidence from one showed patients were waiting an average of two days to see a GP rather than seven, with waiting times to see the GP once at the surgery dropping from 17 to 12 minutes. Patient flow increased by 50%, while DNAs dropped by 60%.

Harry Longman, spokesperson for Patient Access, said the findings were 'quite astonishing': 'Our aim is to enable everyone to understand this and take it on. It's already been used all over the country in very different contexts - inner city, small towns, rural, commuter belt. It is definitely transferrable.'

Dr Simon Coupe, a GP in Christchurch, Dorset, one of the first to pioneer the GP triage system, said: 'It's probably reached a critical mass of practices involved. The effects have been staggering.'

'Practices are sometimes afraid to change. Not everybody likes but they need to be brave and make the step.'

Professor Chris Salisbury, professor of primary healthcare at the University of Bristol and a GP in the city, carried out previous research on Advanced Access.

He said the findings 'definitely have potential', but shouldn't be overstated: 'It rings a bell with the way Advanced Access was brought in. It's sold as doing these wonderful things but when look at it carefully you find it may do but not nearly as dramatically as was stated.'

'Managers will jump on reductions in A&E because they'll see potential for massive saving, but that might be misleading. It's likely the practices doing it are better organised in different areas.'

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READERS' COMMENTS

Anonymous, Manager,
10 Oct 2011
PCT Manager
We have one practice using this method and they are constantly showing the worst access results throughtout the PCT
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Christopher Nevill, GP Partner,
10 Oct 2011
We are a large (14500) semirural practice in mid Wales with some very poor socioeconomic groups. We tried dr triage for over a year and found that it was time and cost effective only for some triagers when they managed to deal with over 60% of calls without appointments. There were other doctors less comfortable with triage (and not necessarily wrong) for whom the time spent of triage was equal to or more than the time saved on patients. SDOC our local exemplar cooperative has also consistently found that they can 'deal' with about 60% of calls with triage and that the service is only effective when triage is functioning at this sort of level..........triage then is not a panacea and depends absolutely on the type of triaging doctor. This unfortunately does not necessarily equate to better medicine and actually places an enormous strain on the so called good triagers and in some ways even more strain on the other triagers if the system is going to 'succeed' = whatever that means.

Dr Nevill, Newtown Medical Practice
Newtown, Powys
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