Tele-First: Evaluation of a 'Telephone First' Approach to Demand Management for General Practice
NIHR sought input on the opportunities of and barriers to the wider roll-out of the ‘telephone-first’ approach by GPs in England. Overall, based on a review of healthcare data and surveys, researchers found that many problems faced by patients can be dealt with by GPs on the phone. However, the ‘telephone first’ approach does not suit all patients or practices and is not the ‘silver-bullet’ for meeting demand.
A recent innovation in general practice involves all patients requesting a face-to-face consultation being asked to speak to a doctor on the ‘telephone first’. Management support for this innovation is being offered by two commercial companies and reported gains include the ability to deal with two thirds of requests on the phone, greatly reduced waiting times for appointments, improved continuity of care, improved patient experience and reduced A&E attendance and emergency admissions.
Funded by the NIHR (National Institute for Health Research) Health Services & Delivery Research Programme, RAND Europe and the University of Cambridge, who come together under the Cambridge Centre for Health Services Research, conducted an independent evaluation of the schemes using a mixture of qualitative and quantitative data collection..
Some questions that the study examined included:
- How does a GP ‘telephone first’ approach affect patient experience and the use of primary and secondary care services?
- What is the impact of GP telephone triage on the nature of consultations for patients and staff, and how appropriate is this approach for hard-to-reach groups?
- What are the cost consequences of the ‘telephone first’ approach in general practice?
The aim was to identify the opportunities and barriers to the wider roll-out of the ‘telephone first’ approach in the UK, and how these barriers could be overcome.
The study involved a time-series and cross-sectional analysis of routine healthcare data, data from national surveys, and primary survey data, including GP and hospital records, patient surveys and economic analyses.
- There is no evidence to support claims by companies offering management support to practices or by NHS England that the ‘telephone first’ approach saves money or reduces the number of hospital referrals.
- The adoption of the ‘telephone first’ approach had a major effect on patterns of GP consultations: the number of telephone consultations increased 12-fold, and the number of face-to-face consultations fell by 38 per cent.
- On average, the ‘telephone first’ approach was associated with an increased GP workload. There was an overall mean increase of 8 per cent in the time spent consulting by GPs. However, this figure masks a wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase.
- There was no evidence that the ‘telephone first’ approach substantially reduced overall attendance at A&E departments or emergency hospital admissions. Its introduction was followed by a small (two per cent) increase in hospital admissions and no initial change in A&E attendance.
Overall, the findings suggest that many problems faced by patients can be dealt with by GPs on the phone. However, the ‘telephone first’ approach does not suit all patients or practices and is not the ‘silver-bullet’ for meeting demand. There is also no evidence to support claims that the approach would, on average, be cost-saving or reduce secondary care utilisation.