Are admin staff doing the job of doctors?

2 September 2013

The past few months have seen GPs criticised for abandoning their patients to A&E. In response Dr Clare Gerada, the chair of the Royal College of GPs, claimed that in the last decade GPs' workload has doubled with doctors now struggling to cope with a surge in demand.

Today's Daily Telegraph suggested a new angle to this unfolding story - namely that one in eight GP practices are using admin staff to 'triage' patients - to decide who needs what treatment and when they need it by.

The Daily Telegraph's claim is based on a recent survey by Campden Health Research. However, while the Daily Telegraph emphasises the dysfunction of "telephone triage", the report by Campden Health suggests that the general system of helping patients over the phone is in most cases effective. 

In its report into telephone triage, Campden Health conducted a survey of 1,195 primary healthcare staff (nurses, doctors and GP practice managers) from all across the UK. The survey's respondents are readers of its professional magazines who chose to submit answers to a questionnaire.

Critically, this means we're talking about a self-selecting sample and so not necessarily a representative one.

GP surgery staff see "telephone triage" as positive development

Of those polled, 56% said their GP surgery used telephone triage. However, this doesn't necessarily mean that they triage all patients - in fact, only 10% of surgeries do this. Most commonly, a surgery triaged 10 to 20% of their patients.

As the Daily Telegraph reports, 13% of GP practice managers said receptionists without a medical background were involved in triaging patients. This equates to some 57 of the 439 practice managers surveyed.

Campden Health quotes the British Medical Association as saying that admin staff without clinical training shouldn't be making clinical assessments. However, the Daily Telegraph's declarative headline "GPs letting receptionists decide who gets seen" relies on evidence that's rather flimsy - a small and self-selecting sample of GP practice managers. 

Even if we were to accept the extrapolation of a small sample, the report argues that the poll data - such as it is - suggests the scheme is successful. Campden Health's researchers note that - unlike the much maligned NHS 111 -

"triage in general practice is, in the majority of cases, being rightly performed by experienced and appropriately qualified healthcare professionals". 

They claim that handling medical inquiries in this way is regarded as a positive development "by both practices and patients". It's certainly the case that 74% of staff sampled said their GP surgery had become more efficient at dealing with patients.

However, it's less clear what patients think about telephone triage. While Campden Research did ask staff to rate how their patients felt about the scheme, the survey doesn't hear directly from patients. Those who responded to the survey are (best intentions aside) speaking on their patients' behalf.

The survey gives us some idea of how GP surgeries operate telephone triage and whether or not staff consider it a helpful procedure. However, it's asking too much of the data to draw any conclusions about how the service operates at a national level. This means the Daily Telegraph's headline, which might be seen as further bad press for GPs, is at risk of exaggerating the problem.


Flickr image courtesy of Karolina Kabat

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