The 'Telephone First' Approach by GPs Does Not Work for All Patients

The 'telephone first' approach in general practice does not work for all patients and can lead to challenges for primary care staff, according to a new study from the Cambridge Centre for Health Services Research, a collaboration between the University of Cambridge and RAND Europe.

In the UK, general practices are struggling with increased demand for appointments, recruiting general practitioners (GPs) and more work being transferred from secondary to primary care. In response to these challenges, some practices have adopted a 'telephone first' approach, in which every patient asking to see a GP is initially phoned back by their doctor on the same day. At the end of this phone call the GP and the patient decide whether the issue needs a face-to-face consultation, or whether it has been satisfactorily resolved on the phone.

In 2017, at the time of the study, two commercial companies provided similar types of management support for general practices adopting the telephone first approach. Advocated in NHS England literature, the approach reported benefits including improved patient and staff satisfaction and reduced work stress. However, such claims were based solely on reports from the commercial companies.

The National Institute for Health Research (NIHR) commissioned an independent evaluation of the approach. The study, which included interviews with 43 patients and 49 primary care staff in practices using the 'telephone first' approach, found wide variation in the views of patients and staff, both positive and negative. The system clearly suited some patients, avoiding the need to visit the surgery, but was difficult for others, e.g. when it was difficult to take a call at work. A substantial proportion of negative comments were about the scheme's operation rather than the principles behind it, for example, difficulty getting through on the phone, lack of flexibility in scheduling the GP's call-back and lengthy delays before receiving the call.

Practices experienced several challenges implementing the approach, for example where the practice did not have the capacity to meet the increased demand for telephone consultations. Although some GPs preferred the 'telephone first' system, others struggled with the altered way of working, seeing fewer patients in person and speaking to more on the telephone.

Prof Martin Roland, Emeritus Professor of Health Services Research at the University of Cambridge, led the study. He said: “Our study of a 'telephone first' approach shows that a number of issues can be resolved with use of telephone consultations in primary care, but the challenge of meeting patient demand remains a major issue for many general practices.”

Dr Jennifer Newbould from RAND Europe, the study's first author, said: “We know in some cases that clinical commissioning groups have funded use of a 'telephone first' approach as a way to support struggling practices. However, our research suggests that practices without appropriate capacity and capability may struggle implementing the approach and this can have a very negative impact on staff morale.”

The full report can be accessed here - https://www.rand/org/pubs/external_publications/EP67853.html.

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Notes to Editors:

• For more information or to arrange an interview with one of the researchers on the project please contact Cat McShane on cmcshane@rand.org.
• The Cambridge Centre for Health Services Research is a collaboration between the University of Cambridge and RAND Europe, a not-for-profit research organisation based in Cambridge. The Centre aims to inform health policy and practice through research on ways of improving care provided in the NHS and other healthcare systems.
• The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
  • Funds, supports and delivers high quality research that benefits the NHS, public health and social care;
  • Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research;
  • Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future;
  • Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partners with other public funders, charities and industry to maximise the value of research to patients and the economy.
• The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.
• This study uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. www.nihr.ac.uk/patientdata