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Telephone triage cuts costs but does not satisfy patients

GPs face widespread patient dissatisfaction with telephone triage-based out-of-hours care ­ and there is a 'stark' lack of evidence to prove it is safe or cuts in-hours GP workload, research has concluded.

Up to 28 per cent of patients are dissatisfied with phone advice and patients receiving care from GP co-operatives are much more satisfied after attending the primary care centre compared with a telephone consultation.

The researchers, who reviewed 24 international studies, including 14 in the UK, warned policymakers to weigh up the impact on patient satisfaction against the benefits of telephone triage in cutting immediate GP workload and reducing costs.

Their review of out-of-hours care, conducted for the Australian Government, rated practice-based services, deput-ising services, A&E care, co-ops and telephone triage ­ including NHS Direct.

Ten studies comparing telephone advice against 'gold-standard care' revealed 'consistent patient dissatisfaction'.

A report in Family Practice (June) said the evidence suggested practice-based and co-op GPs prescribed more appropriately than deputising doctors and junior A&E staff. But there were methodological problems in many of the studies attempting to compare the safety of telephone triage against face-to-face care.

Study author Ruth Leibowitz, from the department of general practice at Monash University in Australia, said out-of-hours care in the UK had changed dramatically in recent years with a 'mushrooming' of GP co-ops and the launch of NHS Direct.

But she warned: 'A specialised out-of-hours service may reduce patient satisfaction if it continues the trend of replacing in-person consultations with telephone consultations.'

Dr Mark Reynolds, chair of the National Association of GP Co-operatives and a GP in Maidstone, Kent, disputed the findings. 'The English experience shows well-conducted telephone advice achieves the same satisfaction rate of well over 90 per cent that face-to-face visits achieve.'

Dr David Lloyd, director of the west London Harmoni co-operative and a GP in Harrow, Middlesex, said: 'The hurdle with out-of-hours services is to make sure people are fully informed about the system they're likely to get.'

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