Title: Tele-First: Telephone triage as an alternative to face to face contact in general practice
Funder: Department of Health (England)

Abstract: A recent innovation in general practice involves all patients requesting a face-to-face consultation being asked to speak to a doctor on the phone first. Reported gains include the ability to deal with two thirds of requests on the phone greatly reduced waiting times for appointments improved continuity of care improved patient experience and reduced A&E attendance and emergency admissions. Management support for this innovation is being offered by two commercial companies (Doctor First and Patient Access) as well as being promoted in NHS England literature. We will work with these companies to evaluate the impact of the scheme on practices enrolled with them. We propose a mixture of qualitative and quantitative data collection. The quantitative analysis will be based on before and after difference-in-differences analysis comparing study practices with all practices in England allowing for baseline and pre-intervention trends and controlling for practice size rurality deprivation and age/sex/ethnicity of the population for the following outcome measures: • Patient experience of making appointments and being able to see or speak to a doctor of their choice using data from the English GP Patient Survey. • Hospital utilisation including A&E attendance outpatient attendance and emergency admissions using Hospital Episode Statistics. • The proportion of patients who leave a practice without changing address as a marker of poor patient experience.For practices using a full triage system we will also carry out a survey of patients who have experience of using the system in the previous two weeks. Questionnaires on patient experience will be sent to a minimum of 15 patients in each of 28 practices (420 patients). In addition we will survey practice managers in all study practices to get their views on the new system.For practices enrolled with Patient Access (n=32) we will carry out additional before-and-after analyses of data remotely extracted from electronic medical records including overall consultation rates waiting times for appointments waiting times in surgery DNA rates recall rate length of consultation and continuity of care (using the UPC or Usual Provider Continuity method). These data are available for up to 2 years prior to the intervention. Our economic analysis will be a cost-consequences analysis with estimates of the costs of implementation and routine operation of the scheme changes in the cost of consultations (both telephone and face to face) referrals and A&E attendances and consequences measured in terms of patient experience.The qualitative element of the study will focus on eight practices which have used the Patient Access approach including surgeries which have overcome problems and some which have returned to a traditional booking system. Interviews will be conducted with four patients or carers and four staff in each of these practices (64 interviews). Patients will be selected to include elderly people people who work people with disabilities and chronic conditions and some with English as a second language. If the findings support the use of telephone triage in these practices our work will show how the approach could be rolled out more widely what the potential barriers would be and how they might be overcome. Our findings will also inform the use of telephone triage short of the full reorganisation offered by the Doctor First and Patient Access models.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE