UK: no evidence that telephone consultations reduce GP workload or hospital referrals

A study by researchers at the Cambridge Centre for Health Services Research found no evidence to support claims that telephone consultation services save money or reduce the number of hospital referrals.

As primary care services in the UK struggle with rising demand, one proposed fix is a ‘telephone first’ approach, in which every patient asking to see a GP is initially phoned back by their doctor on the same day. At the end of the call the GP and the patient decide whether the problem needs a face-to-face consultation, or whether it has been satisfactorily resolved on the phone.

Two commercial companies that provide management support for practices adopting the new approach claim it dramatically reduces the need for face-to-face consultations, reduces workload stress for GPs and practice staff, increases continuity of care, reduces accident and emergency (A&E) attendance and emergency hospital admissions and increases patient satisfaction.

Some of these claims are repeated in NHS England literature, including the assertion based on claims from one of the companies that practices using the approach have a 20 per cent lower A&E usage and that, “The model has demonstrated a cost saving of approximately £100,000 per practice through prevention of avoidable attendance and admissions to hospital.”

The study, led by Martin Roland, emeritus professor of health services research at Cambridge University, found adoption of ‘telephone first’ had a major effect on patterns of consultation. The number of telephone consultations increased 12-fold, and the number of face-to-face consultations fell by 38 percent.

But ‘telephone first’ was on average associated with an overall increase of 8 per cent in the mean time spent consulting by GPs. This figure masks a wide variation, with some practices experiencing a substantial reduction in workload and others a large increase.

Jennifer Newbould, first author of the study, published in the British Medical Journal, said there were some positives. “For example, we found clear evidence that a significant part of patient workload can be addressed through phone consultations. But we need to be careful about seeing this as a panacea. While this may increase a GP practice’s control over day-to-day workload, it does not necessarily decrease the amount of time GPs spend consulting and may, in some cases, increase it.”

The researchers found no evidence that the approach substantially reduced attendance at A&E departments or emergency hospital admissions and overall, secondary care costs increased slightly by £11,776 per 10,000 patients.

British Medical Journal: 2017; 358 doi: https://doi.org/10.1136/bmj.j4197