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Telephone triage increases demand on GP practices

Telephone triage led by GPs and nurses led to an increase in practices workloads, a study carried out across four different areas in the UK has revealed.

The study randomly assigned 42 practices to GP-led triage, nurse-led triage or usual care and found that the mean number of contacts per person after the introduction of GP triage was 33% higher than in practices that continued usual care, while it was 48% higher after the introduction of nurse-led triage.

It comes as NHS England has promoted the use of telephone consultations, with medical director Professor Sir Bruce Keogh calling on GPs to offer same-day telephone consultations as a way of freeing up time and reducing the pressure on A&E departments.

GP leaders have said that the study confirmed their belief that telephone triage ‘generates substantial extra demand’.

The study, published in the Lancet, found that GP triage did substantially reduce the number of face-to-face GP consultations over the 28-day follow-up compared with usual care, but it increased the number of GP telephone consultations per patient ten times and also slightly increased face-to-face consultations with nurses.

Meanwhile nurse-led triage also resulted in a reduction in GP face-to-face contacts and an increase in GP telephone consultations, albeit less so than GP triage, while it led to a 100-fold increase in the mean number of nurse telephone contacts.

Despite the hikes in patient contacts, there was no change in the average overall costs of health care with either GP or nurse triage.

The study authors, who reviewed the case notes of over 16,000 patients, concluded: ‘Introduction of telephone triage delivered by a GP or nurse was associated with an increase in the number of primary care contacts in the 28 days after a patient’s request for a same-day GP consultation, with similar costs to those of usual care.

‘Telephone triage might be useful in aiding the delivery of primary care. The whole-system implications should be assessed when introduction of such a system is considered.’

Dr Richard Vautrey, deputy chair of the GPC, said the findings confirmed GPs’ reports to the BMA that telephone triage had ‘generated substantial extra demand’ and said GP practices needed more support to keep pace with patients’ needs.

Dr Vautrey said: ‘More and more surgeries are offering telephone consultations and triage services and it is possible for these to be effective, as they allow GPs to manage demand for appointments and improve access for patients who don’t necessarily need a face-to-face consultation.  

‘However, practices are also aware of the potential significant issues with the increased use of telephone consultations. A key problem is that general practice as a whole is under real pressure from soaring patient demand and falling funding, which often means that practices don’t have enough GPs or nurses to operate these services in addition to managing their current workload.’

‘Where they are being used GPs have reported to the BMA the outcome that this study confirms, that they often generate substantial extra demand as some patients use them more frequently than they would normally have contacted the practice, whilst other patients would have self-cared without the need to contact the health service at all.’

Lancet 2014; available online 4 August