Newbould J, et al. - Here, researchers assess a telephone first: approach, in which all patients wanting to see a general practitioner (GP) are asked to speak to a GP on the phone before being given an appointment for a face to face consultation. The telephone first approach displays that numerous issues in general practice can be managed via telephone. The approach does not suit all patients or practices and is not a panacea for meeting demand. No evidence was found to support claims that the approach would, on average, save costs or decrease utilization of secondary care.

Methods

• For this research, they designed a time series and cross-sectional investigation of routine healthcare information, information from national surveys, and primary survey data.
• In this study, total 147 general practices adopting the telephone first approach were compared with 10% random sample of other practices in England.

Results

• After the introduction of the telephone first approach, face to face consultations reduced considerably (adjusted change within practices -38%, 95% confidence interval -45% to -29%; P<0.001).
• An average practice experienced a 12-fold increase in telephone consultations (1204%, 633% to 2290%; P<0.001).
• The average amid of both telephone and face to face consultations reduced, but there was an overall increase of 8% in the mean time spent consulting by GPs, although with large uncertainty on this estimate (95% confidence interval -1% to 17%; P=0.088).
• These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase.
• Compared with other English practices in the national GP Patient Survey, in practices using the telephone first approach there was a large (20.0 percentage points, 95% confidence interval 18.2 to 21.9; P<0.001) improvement in length of time to be seen.
• In contrast, other scores on the GP Patient Survey were slightly more negative.
• Introduction of the telephone first approach was followed by a small (2.0%) increase in hospital admissions (95% confidence interval 1% to 3%; P=0.006), no initial change in emergency department attendance, but a small (2% per year) reduce in the subsequent rate of rise of emergency department attendance (1% to 3%; P=0.005).
• There was a small net increase in secondary care costs.