Telephone use in primary care

Editor—Toon's editorial on using telephones in primary care raises several points, in particular the diversity of opinion about the relative merits of clinical skill versus computer algorithms.¹ He may be unaware of some primary care activity that is moving events on.

The primary care collaborative, run by the National Primary Care Development Team, aims to improve access to primary care as one of its three principal objectives. The method advocated is “advanced access,” and a key element of this is the need to shape demand. This can be done by telephone consultation. Telephones can be used for managing same day demand, follow up appointments, and other queries in the same way that was used in the practice that Toon looked at.

The practices track their own data, but collectively we believe that there is a 30-50% reduction in the need for face to face consultation as a result of telephone management of same day demand, and a 15-20% reduction in the need for follow up consultations. These figures are in line with those reported for telephone consultation by Jiwa et al.² Not only are patients more satisfied but they feel less need to book to see their general practitioner if they know that access is easier.

Around 1000 practices covering seven million patients have now been involved in the first phase of the primary care collaborative. By the end of this year we should have practices involved in every primary care trust. The government sponsors and has been most supportive of the programme.

Finally, telephone consultation is only one means of shaping demand; email consultations, expert patients (particularly those with chronic illness), and skill mix are also increasingly used solutions.