Demand for general practice appointments is rising rapidly, and in an attempt to deal with this, many practices have introduced systems of telephone triage. Patients are phoned by a doctor or nurse who either deal with the problem on the phone or agree with the patient whether and how urgently they need to be seen. Many people can have the problem sorted out over the phone so it is sometimes assumed that this is an efficient approach, saving unnecessary GP appointments.
The ESTEEM trial was led by Exeter Medical School and included Dr Tim Holt, Nuffield Department of Primary Care Health Sciences, Oxford as a site Principal Investigator. It was designed to evaluate two forms of triage (delivered by GPs, or by Nurses supported by decision support software) and compare them with 'usual care' (no triage). Forty-two practices across four recruitment centres were randomly allocated to provide one of these three access options for four weeks, following a period of training and 'run-in'. Over 20,000 patients requesting a 'same-day' appointment with a GP were enrolled. They were then followed up through questionnaires and notes review over the 28 days following the initial appointment request.
The study concluded that patients who receive a telephone call-back from a doctor or a nurse are more likely to require further support or advice when compared to patients who see a doctor in person under the usual care arrangement. The research concluded that ‘telephone triage’ systems did not reduce overall practice workload. The costs to the NHS over 28 days were almost identical, so there was no added cost-efficiency through providing triage either.
However, telephone triage was found to be safe in that it did not increase risk of unplanned admissions or Accident and Emergency attendance. Patients were reasonably satisfied with their experience of triage although slightly less so with Nurse-led triage.
Every general practice is a unique environment, where resources and skill mix vary, so the choice of access arrangement needs to be made carefully. The ESTEEM trial provides a lot of detailed information that can help practices and patient groups work together to select the appropriate model. But it should no longer be assumed that telephone triage saves money or reduces overall practice workload.
Campbell J, Fletcher E, Britten N, Green C, Holt T, Lattimer V, Richards D, Richards S, Salisbury C, Calitri R, Bowyer V, Chaplin K, Kandiyali R, Murdoch J, Roscoe J, Varley A, Warren F, Taylor R. Telephone triage for management of same-day consultation requests in general practice (ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis. The Lancet 2014 doi: 10.1016/S0140-6736(14)61058-8