Box 1.

Enablers and barriers to the successful adoption of a telephone first approach in primary care

Understanding demand:
  • Understanding patterns of demand

  • Matching capacity to demand

Staff as pivotal:
  • Reception staff well trained and supported

  • Identified member of staff leading the approach

  • GPs all using the approach consistently

Making modifications to the approach:
  • Making modifications to the approach to overcome challenges

  • Confidence in using the approach flexibly

Educating patients:
  • Clear and updated guidance for patients about the telephone first approach

Insufficient capacity:
  • Insufficient capacity to meet demand; for example, not enough GPs or reception staff to take calls

Staff challenges:
  • Reliance on locums and registrars not familiar with the approach

Patient characteristics:
  • Characteristics of the patient population that may make negotiating the system a challenge, for example, poor English, or unable to take calls at work

Practical problems:
  • Poor mobile coverage in the surrounding area