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Is offering more phone consultations the best way to manage demand? No

Educating patients about self-care would be a better solution to spiralling patient demand, writes Dr Fiona Cornish

However many appointments we offer at the crack of dawn or at dusk, the cry ‘we can’t get an appointment’ still echoes around the waiting room.

Demand is spiralling – consultations in England rose by 75% between 1995 and 2008, according to the RCGP. Telephone triage is effective but time-consuming – my practice tried it for ‘on the day’ urgent appointments, but soon dropped it in favour of more time to see patients.

After three or four minutes talking to a GP, patients often wanted to be seen anway for reassurance – even if we felt it was unnecessary. Patients also had trouble getting through because the phone lines were so busy.

A neighbouring practice admitted that when introducing more phone consultations, they had avoided calling it  ‘triage’ because many patients felt the system was an attempt to fob them off.

 There are other sources of questionable demand that require tackling in other ways. The famous ‘worried well’ are a major drain on resources, as are DNAs. Others feel it is rude to cancel a GP appointment even though they have recovered. And then there are the gyms, schools and universities that demand a ‘letter from the GP’ confirming that patients are fit for an activity.

Improving self-care is a way to reduce demand. Public-education campaigns would help reserve valuable appointments for those who really need them. Open access (especially online booking) will always facilitate inappropriate consultations but rather than telling patients not to come in, we should invite them to come after trying self-care for self-limiting illnesses.

Reducing demand is the responsibility of everyone: politicians, doctors and the public. Rather than focusing on improving telephone access, we need an open debate on the viability of the current GP model.

Dr Fiona Cornish is president of the Medical Women’s Federation and a GP in Cambridge

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