Telephone consultations are increasingly being used as a method to manage rising demand in general practice and there has been a four-fold increase in their use over the last 20 years.
In 2014, the Lancet medical journal published a scholarly article on the ESTEEM trial which was a large study looking at the return rates of patients following GP and nurse telephone consultations. It concluded that telephone consultations were ineffective in managing demand, leading to a 10-fold increase in patients phoning again for unresolved problems. However, it did acknowledge there was a decrease in face-to-face appointment demand as a result.
This study created a lot of debate as to the usefulness of telephone consultations and cast a long shadow over their perceived effectiveness in primary care. In a world where clinicians are already risk averse it was difficult to perceive the benefits of a telephone led consulting service.
Telephone consultations have sometimes been regarded as inferior when compared with face-to-face appointments. It can be argued that we lose the non-verbal communication that is critical when making diagnostic decisions and some clinicians feel less confident managing patients on the telephone, believing it can lead to errors in clinical diagnosis.
We have often been challenged by external stakeholders regarding the true effectiveness of telephone consultations in completely resolving patients’ needs. In response, we conducted our own follow up study to discover how effective telephone consultations were at resolving patients medical needs, or if they returned until seen face-to-face.
We looked at a cohort of 200 patients that initially had a telephone consultation in the beginning of October 2015 (with a spread of presenting conditions to avoid any bias) and then looked at 156 patients that were initially seen face-to-face (with a similar mix of conditions). We followed these patients in the medical records for a six week period to analyse whether they had contacted the practice again with their original complaint.
The results were compelling and showed that there was a 25 per cent return rate after a telephone consultation compared with a 31 per cent return rate after a face-to-face appointment.
This data proved what we had suspected – that telephone consultations are very effective for managing many health conditions in primary care. They are patient centred, offer convenient access and are a safe and effective way of reducing unnecessary visits to A&E. There has not been a single serious incident since we launched the Practice Assist model, with our team having managed over 56,000 calls.
This data challenges the findings of the ESTEEM trial. We did not find a 10-fold increase in return rate for telephone consultations over a six week period and the practices utilising our model have requested more calls per week, such is their belief in the service and its ability to release capacity for local GP teams.
In order to tackle the increasing demand for healthcare we need to be bold and create new ways of delivering care, rather than being resistant to any form of change.
Dr Reggie Sangha. MRCGP
Medical Director - Practice Assist
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