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- Page navigation anchor for Telephone triage for new GP consultationsTelephone triage for new GP consultations
We were interested to read Holt et al.’s article1 giving further evidence that telephone triage for patients requesting new consultations “appears not to offer added efficiency in terms of resource than usual care.”
However, when writing that: “…..triaged patients were in fact more likely to require further consultations…..”, they understate the adverse effects on patients.
Taking the patients’ perspective, the National Association for Patient Participation (N.A.P.P.) remains very cautious about such telephone triage. We have pointed out that GPs undertaking it leave patients suffering increased worry afterwards and a significantly increased use of GP out-of-hours services or A&E units.2 The authors of the ESTEEM study3 subsequently quantified this: “a small increase in GP (6•6%; n=5171) and nurse (5•7%; n=5468) triage when compared with usual care (5•4%; n=5572)”. We disagree that this increase is small and think this statistically-significant, 22.2% more use of emergency and other unscheduled services, when compared to usual care is, particularly for patients, big.
Since forcing patients to seek more help afterwards is such a blunt outcome, we conclude that triaged patients are losing the subtler points of GP consulting provided in usual GP care. This 22% inc...
Competing Interests: President and Patron N.A.P.P, as declared. - Page navigation anchor for Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trialTelephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial
The recent article by Holt et al1 is interesting but misses the point of why many surgeries introduced telephone triage and telephone consulting into normal working. Our surgery changed its appointment system to a variant of Doctor First (R)2 over 2 years ago and it was for a range of reasons. The main ones were that we could neither recruit nor had sufficient space or income to increase our clinical workforce (and doctors in particular) to meet the increasing patient demand utilising face to face appointments. It was not to reduce the overall number of patient contacts. There was also a realisation that many of the more simple consultations such as requests for repeat prescriptions, fit notes and advice on less complex problems could be safely be undertaken on the telephone. Our concern was the clinical risk present in the long waiting times to be seen by a GP and as we stated previously, the systematic introduction of telephone consulting led directly to a significant reduction in the time between first appointment and being seen in specialist clinic for those patients in whom there was a high risk of a cancer diagnosis (2 week wait).3 Our experience is also that for those we now see face to face, the length of consultation has increased in comparison with prior to implementation: given that we generally now only see face to face those who need to be seen and often with the more comple...
Competing Interests: None declared.