Exclusive: Telephone triage is increasingly being used as a means to access healthcare, a survey of 1,195 GPs, nurses and practice managers, On the line: Access to Primary Care in the UK, by Campden Health found. This is both a reflection of this era of mobile technology and an increase in workload due to NHS structural reforms.
Of the practice managers polled, 56% used some form of telephone triage. Most practices (28%) triaged up to 10% of patients, and 9% of practices triaged all their patients.
This seemed to be considered a convenient and efficient way of providing healthcare with 95% of respondents rating it as either ‘moderately’ or ‘extremely’ successful.
However the quality of telephone triage provided could be called into question, with close to half of providers (48%) having received no training in telephone triage. Furthermore, 13% of respondents said receptionists without a medical background were involved and that a large handful of that group did so without any training in telephone triage or help from a nurse or doctor.
Fiona Dalziel, co-lead of the General Practice Foundation at the Royal College of General Practitioners (RCGP) said: “Anecdotally, receptionists are quite good at differentiating urgent from non-urgent situations.
“However, they have had no medical training and are frequently not working to a decision-making protocol and so that leads to increased patient risk.”
With the poll showing that only 44% of practices reported an increase in the number of patients they have been able to see and practices showing a large variation regarding the proportion of problems resolved, ranging from 1% to over 60%, this raises questions about whether a move towards standardised training could improve confidence and increase efficiency levels.
Trainer and consultant of Telephone Consultation Services who trains on behalf of the RGCP said: “Experience as a GP or nurse is not enough. Conversely, many treat it very carefully or have a lot more concern about it than others – terrified in fact of not seeing their patients, which results in a high conversion rate to face to face appointments.”
Following a telephone triage, a median of 90% of patients were give a face-to-face appointment within five days if needed, showing that access to clinical care does not seem to have been significantly comprised amidst increasing demands on GPs.
Patients who book appointments with a GP despite having no medical need may also be a strain on NHS resources. Our survey found that GPs saw a median of 6-10 such patients each day.
Taking the lower value of the median range, with each appointment lasting ten minutes and GPs generally undertaking a minimum of four hours of consultations a day, this amounts to up to a quarter of GP time.
Based on the lower end of hourly rates for locums, £50, this costs the NHS of £836.5 million a year across the UK's 63,854 GPs.
Joe McGilligan, GP partner at Greystone House Medical Practice and chairman of East Surrey Clinical Commissioning Group, said: “We have a cradle to grave responsibility, so obviously people feel we are the point of call for all their woes even if it is not what we are trained for nor adequately resourced in expertise or knowledge.
“I never see patients as wasting my time, just misdirected in what I can offer. Having social workers in the practice as well as health visitors could go a long way to improving everyone’s perception of a good job done.”
Campden's editor-in-chief of primary care, Victoria Vaughan, said: “Clearly NHS money can be better used in primary care by making sure patients are seen by an appropriate professional and that they have the confidence and opportunity to request or be directed to an allied health professional where appropriate.”
Campden thanks all the participants of the survey and is pleased to announce Patient Services Manager Lisa Fall won the iPad and Dr. Tom J Bull won £25 M&S vouchers
To view On the Line in full, click here.
Jenny Chou is Research and Features Editor for Management in Practice and other Campden Health Media brands, including The Commissioning Review, Nursing in Practice and Hospital Pharmacy Europe.