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Is offering more phone consultations the best way to manage demand? Yes

After Sir Bruce Keogh’s call for GPs to offer more telephone consultations, Dr Steven Laitner argues that phone triage can control demand

Six years ago we were struggling with patient demand, as many practices are now, and we saw the potential of switching to a system that starts with clinical assessment of patients with new concerns on the phone in the first instance. I led the introduction of telephone triage at our practice after being convinced by the Cochrane evidence and by my own experience of out-of-hours care.

I remember being taught that 80% of diagnoses can be made on history alone, and not every patient needs a physical examination. For example, for sore throats, recurrent UTIs or chronic problems, phone advice is often all that is required, saving time for both doctor and patient. In just 40% of cases at my practice does the doctor or patient feel a face-to-face consultation is needed.

Triage helps us direct the patient to the most appropriate service – GP, A&E, minor injuries, health visitor, physio, GPSI or pharmacist. It helps us book a consultation that’s appropriate; for example, a patient with mental health issues might need 20-30 minutes rather than 10. We can also remind the patient to bring things such as a urine sample, or prepare work while waiting for the appointment, such as a HADS questionnaire or blood pressure reading from our automatic machine in reception.

Patients generally understand their illness, but not always its severity or urgency or who they should be seen by. Poor access to primary care increases pressure on A&E, but I struggle to think of anything GPs could do to have more of an impact on this than phone triage.

Triage is a big cultural and system change but none of our doctors would go back to the old system now. The system does not mean more work for GPs – in fact, some practices find they have needed less doctor time in the long run.  Although the current calls for more GPs and more GP time are legitimate, what we really need is to work differently.

Dr Steven Laitner is a clinical adviser to Patient Access and a GP in St Albans

Readers' comments (5)

  • In the time you spend talking to a patient on the phone,you could have seen them!
    What are you missing and how long will it be before someone dies?

    A patient with a mental health problem may complain of something very trivial due to a feeling of unworthiness, then contemplate suicide!

    Triage by phone can only work if the patient is well known to the doctor and the doctor can read between the lines, mental health is a very risky area in which many GP's cannot cope.

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  • On a missed diagnosis or an avoidable death the lawyer and the coroner will ask you
    ' Doctor did you put yourself in a appropriate position to make that diagnosis or give the right safe advice'

    Be safe - or safe not sorry. A Doctor undergoing a fitness to practice hearing, a coroner inquest or a court action is likely to suffer mental health and be suicidal. Take care and practice nothing be safe care in absolute terms.

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  • Dr Mustapha Tahir

    Phone consultation is an effective consultation method. This has been proven by several studies. All is required is training for those still apprehensive.

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  • Telephone diagnosis is no longer safe.

    If you could do a 10min face to face why do 10 min telephone diagnosis. You have failed to explain how a telephone diagnosis is as safe (legally and medically safe) as a face to face diagnosis. Speak to a lawyer and also see cases of avoidable deaths, delayed diagnosis etc. in the media as result of telephone advice from nhs direct and OOH etc.
    Stay safe - for patient and yourself.

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  • I think telephone consultations are definitely an option that could be considered. We ALL do it now in any case unless there are some GP s who refuse to take phone calls from patients! We have to stop assuming that increasing patient demand is inevitable. It is not. Patient behaviour was altered literally over night when Practices switched from doing their own on call to an out of hours service. I don't remember any difficulties whatsoever with the transition. One or two GP s now manage tens of thousands of patients out of hours with very few complaints in our area compared with the old days when one GP could be busy all evening and up in the night for ten thousand or less patients. Patients are now used to out of hours triage and are appreciative of the reassurance given on the phone. If the main motive for insisting that the patient travels to see us is medico-legal then I think this is a bit selfish. Like all Practices we have complaints - but I can't remember one relating to a telephone consultations.

    Patients will learn quickly that the doctor does not need to see them for certain symptoms e.g. sore throat, and will probably stop calling. At the moment we are educating them to believe that we need to see them and examine their throats - because that's what we do! We are reinforcing dependent behaviour and we are largely to blame. Make good notes and safety net and check that the patient is happy with the phone consultation and everything will be fine.

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