The views of patients on the introduction of a ‘telephone-first’ approach in general practice: speaking to a doctor on the telephone before making a face to face appointment

Problem

General Practitioners (GPs) in the UK continue to face increasing demand and are struggling to meet patient need. Some have adopted a novel ‘telephone-first’ approach to managing patient requests for a consultation, whereby all requests for an appointment are followed by a telephone call from the GP. Either the issue is resolved during this call or the patient is invited for a face-to-face consultation, usually on the same day. Two commercial companies support practices adopting the approach, which has been advocated by NHS England based on reports of significant benefits, including shorter waiting times, improved access and better continuity of care. We report findings of the first independent evaluation of the approach, focussing on its acceptability to patients.

Approach

Semi-structured interviews were conducted with 43 patients from 12 GP practices using the ‘telephone-first’ approach. Patients who had a recent telephone contact were sampled purposively from questionnaire survey responses to ensure that a range of views were represented, including those of patients in ‘hard-to-reach’ groups (including older people, those who were deaf or hearing impaired, those for whom English was not their first language and working people). Interviews were audio recorded and transcribed verbatim and qualitative analysis was conducted.

Findings

The response of patients to the ‘telephone-first’ approach was extremely varied: some were highly satisfied while others found it unacceptable. When pressed to decide, the majority reported they would choose to keep the ‘telephone-first’ system over the system previously in place, but this belied a complex picture. Based on patient reports, there was considerable variation between practices in how the approach was implemented and the nature of challenges experienced by patients using it. Patients reported a wide range of advantages and disadvantages in five categories (access to care; consultation quality; continuity of care; patient safety and confidentiality), but with contrasting views in each case as to whether the approach led to improvements or was a hindrance. Factors identified as having an impact on acceptability included practice and system characteristics (e.g. capacity to meet demand, system flexibility) and patient characteristics and resources (e.g. communication skills, confidence /assertiveness, flexibility of daily schedule, mobile phone access, ease of access to the surgery). The acceptability of the approach with respect to particular ‘hard-to-reach groups’ was considered in relation to these characteristics.

Consequences

Although the study shows the potential for a significant proportion of patients’ problems to be dealt with on the telephone, this approach suits some patients well while others find it much less acceptable. There was variation in the way the approach had been implemented within practices, with some catering considerably better for the needs of particular patient groups than others. A range of factors were identified that need to be considered by practices planning the approach.