Will you have to prove you need to see your GP?

“Now you need to PROVE you need to see the doctor: Hundreds of GPs are assessing patients in three-minute phone calls before granting face-to-face appointments”

Daily Mail, 28 November 2016

We haven’t seen evidence that GPs are asking patients to prove they need to see them over the phone, although the Daily Mail’s headline does reflect some doctors’ concerns about the quality of care provided through ‘telephone triage’ systems.

The Mail reports that about 180 GP surgeries are using this approach systematically as a way to manage high demand for their services (that's out of about 7,700 practices in England). Instead of booking an initial face-to-face appointment or receiving an initial call from a nurse, patients are called by a GP who carries out an initial consultation over the phone. 

The approach isn’t completely unusual: 12% of GP consultations take place over the phone, according to a 2014 study published in the Lancet medical journal. The idea is to prioritise face-to-face appointments with patients who seem to need help most urgently, and to avoid unnecessary ones. Feedback from surgeries that have tried this approach suggests that many patients are actually quite happy to receive quick advice over the phone instead of coming in to the surgery.

So the approach isn’t designed to cruelly ration access to GPs. People have a right to register with an NHS surgery and a right to treatment by a GP at that surgery. GP Access and Productive Primary Healthcare, two firms that promote telephone triage systems, told us that they had never heard of a case where a GP refused a face-to-face appointment when the patient asked for one during the telephone call.

The Mail’s story also refers to “three-minute phone assessments”. Productive Primary Healthcare told us that three minutes was the average length of a call once surgeries had implemented their system, but stressed that it doesn’t advise that calls be a particular length or have a time limit. GP Access said the same, although it bases its training for surgeries on an average call length of five minutes.

Of course, none of this guarantees that some patients don’t feel ‘fobbed off’ by telephone consultations, as campaigners quoted by the Mail put it, or that there aren’t legitimate concerns about patient safety and quality of care. Sir Denis Pereira Gray, former President of the Royal College of GPs, has raised concerns that GPs will miss important visual clues that patients are unwell if they don’t see them face-to-face, particularly when it comes to vulnerable and elderly patients.

It’s also not clear that the scheme either saves time for GPs or generates cost savings for the NHS overall. The largest study we’ve seen found that ‘telephone triage’ actually increased GP workloads, in contrast to previous research,  since they ended up spending more time on the phone. Patients who were given telephone consultations were more likely to call back or have other contact with the NHS again over the next 28 days, so:

“Any reduction in GPs’ workload from reduced numbers of face-to-face contacts was more than compensated for by a substantial increase in the number of telephone contacts undertaken in GP triage.”

And since patients were more likely to have further appointments, the study found that the average overall cost to primary care services from ‘telephone triage’ with a GP, ‘telephone triage’ with a nurse, or an initial face-to-face appointment was roughly the same.

GP Access has raised concerns about this study. It said that it didn't reflect how GP telephone triage services can be used most effectively, and it published a point-by-point comparison which outlined the differences between its own work and use of GP telephone triage in the study.

An independent evaluation of the Prime Minister's GP Access Fund, a government fund to help improve access to GP services, found that: 

"Telephone-based GP consultation models have proved... popular and successful. There is growing evidence to suggest that investment in telephony infrastructure can be cost effective due to the GP time savings that are being achieved."

Another independent study into the use of GP telephone triage is due to report its findings in March.

Update 29 November 2016

This article was updated shortly after publication to reflect GP Access' concerns about the ESTEEM study, and to include the independent evaluation of the Prime Minister's GP Access Fund.