The views of staff of a ‘telephone first’ approach in primary care, speaking to a doctor on the telephone first before making a face to face appointment

Problem

General practitioners (GPs) in the UK continue to struggle with the pressures of the demands on general practice. Some GPs, looking for a way to better manage patient demand, use the support of commercial companies to implement a ‘telephone first’ approach. All requests by a patient for a consultation with a GP are followed by a telephone call to the patient by the GP. The problem is either resolved on the phone by the GP, or the patient is invited for a face to face consultation usually on the same day. Such approaches are advocated in NHS England literature(1) based on the benefits reported by commercial companies. We report findings from the first independent evaluation of such an approach.

Approach

Semi-structured interviews were conducted with 49 members of staff (GPs, practice managers, administrative staff and nurses) from 12 GP surgeries adopting the ‘telephone first’ approach. Surgeries varied in the population served, list size, number of GPs and geographical location. Interviews were audio recorded and transcribed verbatim; qualitative analysis followed established principles.

Findings

A variety of reasons were reported by participants as to why the practice team had wished to adopt the ‘telephone first’ approach, these included problems with the existing appointments system, wanting to try something innovative and being encouraged to do so by CCGs. In some surgeries implementation of the approach had been smoother than others. Staff reported a range of experiences with the approach, and noted impacts upon the nature of general practice in a number of areas. These included practice culture, staff workload and continuity of care. Staff also spoke about the impact of the ‘telephone first’ system on patient safety and on hard to reach groups (such as patients for whom English was not their first language, older people and deaf or hearing impaired people). GPs and reception staff reported how the nature of their daily work had changed under the new system, changes in the way the practice was managed were also noted. Whilst a number of factors influenced how well the system functioned within a practice, from our data we were able to identify a number of enablers and barriers to successful adoption of a ‘telephone first’ approach.

Consequences

Our research identifies enablers and barriers to successful implementation which may assist practices in the future in deciding if they should adopt such an approach. The ‘telephone first’ approach is not a panacea for all practices, but does suggest the potential for a significant proportion of patients’ needs to be met without a face to face consultation.References1 NHS England (2013) High quality care for all, now and for future generations: Transforming urgent and emergency care services in England. NHS England