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Telephone triage ‘increases patient demand’

4 August 2014

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Carrying out consultations over the phone does not reduce pressure in busy surgeries, researchers have found. 

The study, published in The Lancet, found that patients who receive a telephone call-back from a doctor of nurse following a request for same-day consultation are more likely to require further support compared to patients who see a GP in person. 

Researchers also discovered that telephone triage is no cheaper than care provided through face-to-face appointments. 

The University of Exeter trial involved more than 20,000 patients at 42 surgeries across England. 

Practices were randomly assigned to continue delivering care in the usual way, or to offer same day advice over the phone. 

Over 2-3 months, researchers examined patient consulting patterns over the 28 days following their same-day consultation request. 

Practices offering triage by a GP found a 33% increase in the total number of patient contacts for those who had requested a same-day appointment. In practices offering nurse triage, there was a 48% increase in patient contacts. 

Overall, patients reported a good experience of care provided by the study practices, although patients from practices providing nurse triage were slightly less satisfied than those from the other practices.

Lead author Professor John Campbell, of the University of Exeter Medical School, said: “Up to now, it has been widely thought that introducing a triage system might be an efficient way of providing same-day access to healthcare advice. However, our study suggests that introducing triage may not represent the most efficient use of doctor or nurse time. Patients who receive over-the-phone support are more likely to seek follow-up advice, meaning that the workload is only redistributed, whilst the costs are the same.

Practices thinking about introducing triage might benefit from looking at our findings carefully, and considering whether introducing triage is really likely to be of benefit to their patients, or to the primary care practice team. Healthcare managers should consider the implications across the whole system of introducing triage on a wider scale, especially given the staffing constraints and challenges faced by the NHS.”

Dr Richard Vautrey, deputy chair of the British Medical Association’s GP committee 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. 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.

“It is also important that we get the balance right and do not think over the phone or other non-visual means of assessment can replace all face-to-face consultations. There are many conditions that can only be safely treated by direct examination in the GP practice. This is why we need to ensure we have enough GPs, practice staff and resources to treat the steadily rising level of demand for GP appointments, especially from our ageing population.”

The full study is available to view on The Lancet website.