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Telephone-first strategy 'does not necessarily suit all practices'

Study finds introduction of T1 system increased workload at some general practioners.

Study finds introduction of T1 system increased workload at some general practioners

Many UK general practices struggle with rising patient demand combined with staff recruitment problems.

This quantitative study evaluated the 'telephone first' (T1) strategy. This is a system whereby patients, requesting an appointment, speak to a GP on the phone that day before being given a face-to-face (f2f) appointment.

Data from 147 T1 practices were compared with a 10% random sample of English practices. Following the introduction of T1 the number of consultations increased from a mean average of 16.5 a day per 1,000 patients to 21.8. The number of f2f consultations decreased substantially (from a mean of 13 to 9.3).

The practices had a 12-fold increase in telephone consultations with the average duration decreasing over time, as did the duration for f2f consultations. The national GP Patient Survey for the T1 practices reported improvements in the length of time waited to be seen but some decreases in other scores. 

A questionnaire sent to 1,873 patients in T1 practices reported 55% found it more convenient, 22% less and 23% no different.

The introduction of T1 was followed by a small increase in hospital admissions, a subsequent decrease in emergency department attendance and a small net increase in secondary care costs. 

There was wide variation reported on overall practice workload. Some practices experienced a substantial drop and others reported a substantial increase. This suggested that telephone-first systems did not necessarily suit all practices and all practice populations.

Newbould J, Abel G, Ball S et al (2017) Evaluation of telephone first approach to demand management in English general practice: observational study. British Medical Journal. 358, j4197.

Vari M Drennan is professor of health care and policy research at Kingston University and St George’s University of London

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