Having a conversation with a GP before you consult with them makes a lot of sense, empirically.
I am sure we can all imagine the benefits.
Maybe the issue we have can be sorted out on the phone and not need us to make an apppointment, take time out of work, travel, wait, and in many countries pay for a consultation.
Maybe the issue we have will need some investigations, which could be organised before the face to face consultation so that the GP can help us more effectively when we do meet face to face.
Maybe we can be directed to see a nurse, pharmacist or counsellor who is better suited to deal with our problem.
Maybe the GP will be happier when we do see them because they are prepared for the consultation, and not be feeling that their hard earned skills are being used for low acuity problems.
I have to declare a bias towards the idea of GP led telephone triage, based on the fact that as a working GP I have personal experience of the overwhelming demand patients can create in our traditional model practice that was designed for a time when we had fewer people to care for, who had less complex multimorbidities, lower expectations of the capacity and capability of health services, and higher levels of self and family care.
The “doctor-in-a-box” model that developed in the 1900s has to change to meet the needs of the 21st century patient, and has opportunities to do so in a tech-enabled world that Anuerin Bevan would never have dreamed about.
I value academic study of our profession, I believe that making informed choices about how we progress our services relies on unbiased evaluation of what works well and what doesn’t.
The word unbiased is an essential part of that statement and it’s really frustrating when academic studies of “telephone triage” by GPs present their findings with apparent focus on the negative aspects of the service, and when results do detail positive outcomes, authors and commentators emphasise the negative aspects in discussions and abstracts.
NZ commentators reading : http://www.bmj.com/content/358/bmj.j4345, and http://www.bmj.com/content/358/bmj.j4197 put focus on an INCREASE in the number of consultations found in “telephone first” services, despite the fact that the “change was made up of a substantial reduction in face to face consultations, which reduced from a mean of 13.0 (SD 4.5) to 9.3 (SD 5.5), and an increase in telephone consultations from a mean of 3.0 (SD 4.5) to 12.2 (SD 7.5) telephone consultations/day/1000 patients.”
These systems provide many more opportunities for patients to access care.
NZ commentators focus on an overall increase of 2% in ED attendences but ignore the fact that “Heterogeneity identified with a random effect shows that these figures mask considerable differences between individual practices, some of which had large increases in emergency department attendances, with others showing large decreases.”
They focus on the negative aspects of patient experience in that “just under a quarter reported that it was more difficult to communicate with the GP on the phone, the main reasons being given that it was difficult to explain the problem or that the doctor could not see the problem” and ignore the fact that “nearly two thirds found it made no difference, and 11.7% found it easier to communicate on the phone.”
They ignore the fact that the authors found an “improvement in patients’ rating of time to be seen or spoken to (increase of 20 points on a 0-100 point scale) compared with national trends” and that this was “large and immediate”.
They focus on the “estimated ..overall increase of 8% in the mean time spent consulting by GPs” and ignore the fact that “the average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase” – and that the estimate came with “large uncertainty” (95% confidence interval −1% to 17%; P<0.09)
They don’t mention the fact that there was a “small increase in continuity of care index after the introduction of the new system.”
I wouldn’t be surprised if NZ commentators looked at Catherine Bell’s article in the BMJ “Does Peppa Pig encourage inappropriate use of primary care resources?” BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5397 (Published 11 December 2017) and argued that it too demonstrates that telephone triage clearly is a waste of resources.
NZ commentators ignore the fact that our system is very different from that in the UK and the fact of a patient co-payment makes comparisons between the outcomes of trials like this difficult to translate to the NZ context.
The UK system does not filter patients who have to speak to the a doctor on the telephone, every patient HAS to have a phone call with a GP before they can be offered an appointment. This process is not the same as NZ telephone triage where patients are able to make enquiries and be directed to admin or nursing services, they can make delayed consultations if they wish and telephone triage by GPs means they are calling back patients who are seeking same day consultations (or requesting a telephone consultation.)
I could go on and on…but in summary – let’s study the impacts in NZ and not rely on overseas based studies to draw conclusions about our health system, and when the outcomes of a study don’t make empirical sense, let’s consider it a warning to look really carefully at the methodology and results.