Telephone first approach no panacea for reduced GP workload

A "telephone first" system in which GPs speak to all patients to decide whether a problem can be resolved over the phone does not necessarily reduce workload nor is there evidence it saves money, according to a study published in the BMJ.

Researchers from the Cambridge Centre for Health Services Research analysed routine health data from 147 English general practices adopting the telephone first approach compared with a 10 per cent random sample of other practices in England. They also reviewed responses to patient satisfaction surveys.

They were investigating the effectiveness of a telephone first system in which a GP decides whether a health issue can be resolved over the phone or if a face-to-face appointment or one with another professional, such as a nurse or pharmacist, might be more appropriate.

Adoption of a telephone first approach led to fewer face-to-face consultations (mean of 13 to 9 per day/1000 patients) and more telephone calls (mean of 3 to 12 per day/1000 patients), suggesting that much of the work of general practice can be managed on the telephone. But there was an overall increase of 8 per cent in the mean time spent consulting by GPs (albeit with large uncertainty on this estimate).

Wide variation was found among practices in how well the system functioned, with some noting large reductions in workload and others reporting increases – though a telephone first system was associated overall with an increased GP workload. Many patients reported being attended to much more quickly in telephone first practices but other aspects of the patient experience were found to be slightly more negative, such as difficulty communicating over the phone.

There was also no significant associated reduction in attendances at hospital emergency departments.

In a linked BMJ editorial, Professor Brian McKinstry at the University of Edinburgh and colleagues commented that telephone first systems alone "will not solve the perennial problem of ensuring timely, safe, effective, and equitable access to primary care when demand is increasing and resources are not".

They urge practices "to think carefully about the wider, possibly unanticipated, consequences of a switch to a telephone first system" and call on policy makers "to reconsider their unequivocal support for such systems. It is also yet another reminder of the importance of independent evaluation of initiatives before investment in widespread implementation".

Link: Evaluation of telephone first approach to demand management in English general practice: observational study